Cerebral and somatic oxygen saturation decrease after delayed sternal closure in children after cardiac surgery

Area of Science:

• Pediatric Cardiac Surgery
• Critical Care Medicine
• Biomedical Engineering

Background:

• Delayed sternal closure is a strategy used after complex pediatric cardiac surgery.
• This procedure can lead to temporary reductions in cardiac output and hemodynamic instability.
• Near-infrared spectroscopy (NIRS) offers a non-invasive method to monitor regional oxygen saturation.

Purpose of the Study:

• To investigate the correlation between cerebral and somatic regional oxygen saturation (NIRS) and hemodynamic compromise indicators.
• To assess the impact of delayed sternal closure on regional oxygenation in pediatric cardiac surgery patients.
• To evaluate NIRS as a potential surrogate for mixed venous oxygen saturation during this critical period.

Main Methods:

• A prospective study of 36 pediatric patients undergoing delayed sternal closure post-cardiac surgery.
• Continuous monitoring of cerebral and somatic regional oxygen saturation using NIRS.
• Analysis of hemodynamic parameters, lactate levels, and inotrope scores at multiple time points before and after sternal closure.

Main Results:

• Regional oxygen saturation (cerebral and somatic) significantly decreased after delayed sternal closure.
• Increased heart rate, lactate levels, and left atrial pressure indicated mild hemodynamic compromise.
• Somatic oxygen saturation recovery differed between biventricular and single-ventricle physiology groups.

Conclusions:

• Delayed sternal closure is associated with transient hemodynamic compromise in pediatric cardiac surgery patients.
• NIRS-derived cerebral and somatic oxygen saturation levels reflect this compromise.
• NIRS monitoring may serve as a valuable tool for managing patients during delayed sternal closure.