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Cerebral oxygenation during paediatric cardiac surgery: identification of vulnerable periods using near infrared
P E Daubeney1, D C Smith, S N Pilkington
1Wessex Cardiothoracic Centre, Southampton General Hospital, UK.
Insights
Neurologic injury is a risk in pediatric cardiac surgery. Near-infrared spectroscopy monitoring reveals that pre-bypass and early post-bypass periods are critical for maintaining adequate cerebral oxygenation.
Area of Science:
- Pediatric Cardiac Surgery
- Neurocritical Care
- Medical Device Technology
Background:
- Neurologic sequelae are recognized complications following pediatric cardiac surgery.
- Monitoring cerebral oxygenation may identify periods at risk for neurologic injury.
- Near-infrared spectroscopy (NIRS) offers a method for assessing regional cerebral oxygenation (rSO2).
Purpose of the Study:
- To measure regional cerebral oxygenation in children undergoing cardiac surgery using NIRS.
- To identify vulnerable periods for neurologic injury during pediatric cardiac surgery.
- To correlate rSO2 with hemodynamic parameters throughout surgical procedures.
Main Methods:
- An observational study involving 18 pediatric patients (median age 1.3 years) undergoing cardiac surgery.
- Seventeen patients underwent cardiopulmonary bypass, and 8 experienced circulatory arrest.
- Regional cerebral oxygenation was monitored using the INVOS 3100 cerebral oximeter.
Main Results:
- Ten patients showed a decrease in rSO2 (> or = 15% points) before bypass, with 5 reaching <35% saturation.
- rSO2 increased by a mean 18% points upon initiation of bypass.
- During circulatory arrest, rSO2 decay rate was temperature-dependent (0.25%/min at <20°C; 2%/min at >20°C).
Conclusions:
- The pre-bypass and early post-bypass periods represent vulnerable times for cerebral oxygenation.
- NIRS is a valuable tool for monitoring oxygen supply/demand, particularly during circulatory arrest.
- Maintaining adequate cerebral oxygenation is crucial during specific phases of pediatric cardiac surgery.
Objective:
Neurologic sequelae remain a well recognised complication of paediatric cardiac surgery. Monitoring of cerebral oxygenation may be a useful technique for identifying vulnerable periods for the development of neurologic injury. We sought to measure regional cerebral oxygenation in children undergoing cardiac surgery using near infrared spectroscopy to ascertain such vulnerable periods.
Methods:
Observational study of 18 children (median age 1.3 years) undergoing cardiac surgery (17 with cardiopulmonary bypass, 8 with circulatory arrest). Regional cerebral oxygenation was monitored using the INVOS 3100 cerebral oximeter and related to haemodynamic parameters at each stage of the procedure.
Results:
Prior to the onset of bypass, 10 patients had a decrease in regional cerebral oxygenation of > or = 15% points, reaching an absolute haemoglobin saturation less than 35% in 5 cases. The most common cause was handling and dissection around the heart prior to and during caval cannulation. With institution of bypass, regional cerebral oxygenation increased by a mean 18% points to a mean maximum of 75%. During circulatory arrest regional cerebral oxygenation decreased with rate of decay influenced by temperature at onset of arrest (0.25%/min at < 20 degrees C; 2%/min at > 20 degrees C). Reperfusion caused an immediate increase in regional cerebral oxygenation followed by a decrease during rewarming. Discontinuation of bypass caused a precipitous decrease in regional cerebral oxygenation in 5 patients, reaching less than 50% in 3 patients.
Conclusions:
These observations suggest that the pre- and early post-bypass periods are vulnerable times for provision of adequate cerebral oxygenation. Near infrared spectroscopy is a promising tool for monitoring O2 supply/demand relationships especially during circulatory arrest.
