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Correlation Between Cerebral Near-Infrared Spectroscopy and Hoffman Index With Central Venous Saturation in Children
Violeta Castañuela Sánchez1, Luis Antonio García Benitez2, José Alfredo Hernández Suárez1
1División de Cirugía Cardiovascular. Unidad de Cuidados Intensivos Cardiovasculares. Instituto Nacional de Pediatría. Mexico City, Mexico.
Insights
The Hoffman index, derived from near-infrared spectroscopy (NIRS), shows a stronger correlation with central venous oxygen saturation (SvO2) than cerebral NIRS alone. This suggests the Hoffman index is a valuable tool for monitoring hemodynamics in pediatric patients post-congenital heart surgery.
Area of Science:
- Cardiology
- Pediatric Surgery
- Biomedical Engineering
Background:
- Post-cardiopulmonary bypass surgery for congenital heart disease often leads to hemodynamic instability.
- Monitoring tissue oxygen balance is crucial for patient management.
- Central venous saturation (SvO2) offers insights but is invasive and not continuous.
Purpose of the Study:
- To investigate the relationship between SvO2, the Hoffman index, and cerebral NIRS (NIRSc) in pediatric patients.
- To evaluate the utility of noninvasive NIRS-derived measures for hemodynamic monitoring.
Main Methods:
- Prospective study involving 41 pediatric patients undergoing cardiovascular surgery with cardiopulmonary bypass.
- Continuous monitoring of cerebral and renal NIRS values.
- Intermittent measurement of SvO2 upon admission and at 6 and 12 hours post-admission to the CICU.
Main Results:
- The Hoffman index demonstrated a stronger overall correlation with SvO2 (r=0.72, P<.001) compared to NIRSc (r=0.55, P<.001 at 12h).
- High correlations were observed between the Hoffman index and SvO2 across different patient groups, including biventricular repair, univentricular physiology, and neonates.
- The correlation between Hoffman index and SvO2 was strongest at admission (r=0.64, P<.001).
Conclusions:
- The Hoffman index, calculated using multisite NIRS, is a more reliable indicator of global perfusion and correlates better with SvO2 than cerebral NIRS alone.
- Both the Hoffman index and NIRSc can serve as valuable noninvasive tools for hemodynamic monitoring in pediatric patients after congenital heart surgery.
- These findings support the integration of NIRS technology for enhanced perioperative care in this vulnerable population.
Abstract:
Background: After surgical repair of congenital heart disease with cardiopulmonary bypass, it is common for patients to present with a decrease in cardiac output with hemodynamic instability. Treatment goals should focus on achieving a balance between tissue oxygen availability and consumption. Central venous saturation (SvO2) provides valuable information about hemodynamics and global perfusion; however, it is not continuous and it is invasive. Near-infrared spectroscopy (NIRS) is a noninvasive technology that allows immediate and continuous monitoring of regional oxygen extraction and consumption in different organs. With multisite NIRS values (brain and kidney), global perfusion can be estimated through the Hoffman index. In this study we sought to determine the relationship between SvO2, Hoffman index, and cerebral NIRS (NIRSc) values in pediatric patients undergoing cardiovascular surgery with cardiopulmonary bypass. Methods: Prospective study in patients undergoing cardiovascular surgery with cardiopulmonary bypass who were admitted to the cardiovascular intensive care unit (CICU) at the Instituto Nacional de Pediatría, in Mexico City, from March 2021 to February 2022. Central venous oxygen saturation, cerebral, and renal NIRS values were recorded upon admission to the CICU, at 6 and 12 h. Results: A total of 41 patients were included with a median age of 19 months, 25/41 (61%) of the patients were male. The correlation between cerebral NIRS (NIRSc) and SvO2 was higher at 12 h (r = 0.55, P < .001), while a greater correlation was observed between Hoffman index and SvO2 at admission (r = 0.64, P < .001). When considering the 123 measurements, a better correlation was observed between Hoffman index and SvO2 (r = 0.72, P < .001), including patients with biventricular repair (r = 0.64, P < .001), univentricular physiology (r = 0.83, P < .001), and neonatal patients (r = 0.79, P < .001). Conclusion: The Hoffman index has a stronger correlation with SvO2 compared with NIRSc; both can be used as tools for hemodynamic monitoring of patients who underwent surgery for congenital heart disease.
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