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Changes in cerebral oxygen saturation correlate with S100B in infants undergoing cardiac surgery with cardiopulmonary
Samer Abu-Sultaneh1, David A Hehir, Kathleen Murkowski
11Section of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN. 2Division of Critical Care, Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI. 3Division of Cardiology, Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI. 4Division of Neonatology, Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI. 5Division of Quantitative Health Sciences, Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI. 6Division of Cardiothoracic Surgery, Department of Pediatrics, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI. 7Banyan Biomarkers Inc., Alachua, FL. 8Department of Pediatric Anesthesiology, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI.
Insights
A wide arterial-cerebral oxygen saturation difference during cardiopulmonary bypass in infants is linked to higher S100B brain injury biomarker levels. This finding suggests a modifiable risk factor for neurological injury in pediatric cardiac surgery.
Area of Science:
- Biomedical Engineering
- Pediatric Cardiology
- Neuroscience
Background:
- Infants undergoing cardiac surgery with cardiopulmonary bypass are at risk for neurological injury.
- Cerebral saturation monitoring using near-infrared spectroscopy (NIRS) and serum biomarkers like S100B are used to assess brain health.
- The relationship between these measures in this vulnerable population requires further investigation.
Purpose of the Study:
- To investigate the relationship between cerebral oxygen saturation measured by NIRS and the serum biomarker S100B in infants undergoing cardiac surgery.
- To determine if perioperative cerebral saturation differences are associated with elevated S100B levels, indicating potential brain injury.
Main Methods:
- A prospective cohort study was conducted at a single-center children's hospital.
- Forty infants (1-12 months) undergoing cardiac surgery with cardiopulmonary bypass were enrolled.
- Cerebral saturation (NIRS) and serum S100B levels were measured over 72 hours post-surgery.
Main Results:
- Serum S100B levels significantly increased during cardiopulmonary bypass in all patients.
- A wide arterial-cerebral oxygen saturation difference (greater than 50%) during cardiopulmonary bypass was associated with a significantly higher peak S100B level.
- Patients without preoperative cyanosis showed a higher S100B peak post-cardiopulmonary bypass.
Conclusions:
- A significant difference in arterial-cerebral oxygen saturation, as measured by NIRS during cardiopulmonary bypass, is linked to elevated S100B serum levels.
- This wide arteriovenous difference may serve as a modifiable risk factor for perioperative neurological injury in infants undergoing cardiac surgery.
Objectives:
The relationship of cerebral saturation measured by near-infrared spectroscopy with serum biomarker of brain injury S100B was investigated in infants undergoing cardiac surgery with cardiopulmonary bypass.
Design:
Prospective cohort study.
Setting:
Single-center children's hospital.
Patients:
Forty infants between 1 and 12 months old weighing greater than or equal to 4 kg with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass were enrolled.
Interventions:
None.
Measurements And Main Results:
Serum S100B was measured at eight time points over 72 hours using enzyme-linked immunosorbent assay. Physiologic data including arterial, cerebral, and somatic regional oxygen saturations measured by near-infrared spectroscopy were synchronously recorded at 1-minute intervals from anesthesia induction through 72 postoperative hours. The arterial-cerebral oxygen saturation difference was calculated as the difference between arterial saturation and cerebral regional saturation. Thirty-eight patients, 5.4 ± 2.5 months old, were included in the analysis; two were excluded due to the use of postoperative extracorporeal membrane oxygenation. Seventeen patients (44.7%) had preoperative cyanosis. S100B increased during cardiopulmonary bypass in all patients, from a median preoperative baseline of mean ± SE: 0.055 ± 0.038 to a peak of 0.610 ± 0.038 ng/mL, p less than 0.0001. Patients without preoperative cyanosis had a higher S100B peak at the end of cardiopulmonary bypass. Although the absolute cerebral regional saturation on cardiopulmonary bypass was not associated with S100B elevation, patients who had arterial-cerebral oxygen saturation difference greater than 50 at any time during cardiopulmonary bypass had a higher S100B peak (mean ± SE: 1.053 ± 0.080 vs 0.504 ± 0.039 ng/mL; p < 0.0001).
Conclusions:
A wide cerebral arteriovenous difference measured by near-infrared spectroscopy during cardiopulmonary bypass is associated with increased serum S100B in the perioperative period and may be a modifiable risk factor for neurological injury.
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