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406 Validating Cerebral NEAR-INFRARED SPECTROSCOPY in Postoperative Pediatric Cardiac Surgery.
  1. P. S. McQuillen1,
  2. S. E.G. Hamrick1,
  3. M. Nishimoto1,
  4. C. Bottrell1,
  5. L. A. Fineman1,
  6. D. V. Glidden2,
  7. S. P. Miller1,3
  1. 1Pediatric Heart Centerand Departments of
  2. 2Epidemiology and Biostatistics
  3. 3Neurology, University of California San Francisco, San Francisco, CA

Abstract

Objective To determine if changes in cerebral oximetry (via near-infrared spectroscopy [NIRS], Invos 5100) predict changes in central venous oximetry and to determine the independent association of laboratory and physiologic variables with changes in cerebral or central venous oximetry.

Design Prospective cohort study.

Setting University tertiary care center, pediatric cardiac intensive care unit.

Patients Sixty-seven consecutive postoperative pediatric cardiac surgery patients (median age 0.3 years; range (1 day-35 years).

Measurements Temporally correlated regional cerebral oxygen saturation (rSO2) with laboratory (hematocrit, arterial blood gas, lactate and central venous oxygen saturation [SvO2]) and physiologic (temperature, heart rate, mean blood pressure, and pulse oximetry) variables in the first postoperative day.

Results Although rSO2 is correlated with SvO2 (Spearman's Rho = 0.71, p < .0001), individual values have wide limits of agreement (-26-23%). Similarly, there is a weak but significant correlation of change in rSO2 (ΔrSO2) with change in SvO2 (ΔSvO2) (Spearman's Rho = 0.37, p < .0001), however, again with wide limits of agreement (-18-19%). Changes in different variables are associated with change in ΔrSO2 or ΔSvO2. Change in arterial pressure of carbon dioxide (ΔPaCO2) and mean arterial pressure (ΔMAP) are associated with ΔrSO2 (ΔPaCO2 coefficient = 0.35, p < .0001; ΔMAP coefficient = 0.07, p = .01) but not ΔSvO2. Change in arterial oxygen saturation (ΔSaO2), and heart rate (ΔHR) are associated with ΔSvO2 (ΔSaO2 coefficient = 0.41, ΔHR p = .04; coefficient = -0.12, p = .05;) but not ΔrSO2.

Conclusions Neither individual values, nor trends in cerebral oximetry are surrogate measures of central venous oximetry in postoperative pediatric cardiac patients. The selective association of changes in physiologic variables known to strongly influence cerebral blood flow (PaCO2 and MAP) with cerebral oximetry compared with central venous oximetry supports the hypothesis that cerebral oximetry uniquely monitors cerebral oxygen delivery.

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