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How to Administer Near-Infrared Spectroscopy in Critically ill Neonates, Infants, and Children
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Cerebral and somatic oxygen saturation decrease after delayed sternal closure in children after cardiac surgery.

Robert Horvath1, Shirah Shore, Steven E Schultz

  • 1Division of Pediatric Cardiology, University of Miami Leonard Miller School of Medicine and Holtz Children's Hospital/Jackson Memorial Hospital, Miami, FL 33136, USA.

The Journal of Thoracic and Cardiovascular Surgery
|August 8, 2009
PubMed
Summary
This summary is machine-generated.

Delayed sternal closure in pediatric cardiac surgery patients can cause temporary hemodynamic compromise. Near-infrared spectroscopy (NIRS) monitoring of cerebral and somatic oxygen saturation may help assess this compromise during recovery.

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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.