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Near-Infrared Spectroscopy and Vascular Occlusion Test for Predicting Clinical Outcome in Pediatric Cardiac Patients: A Prospective Observational Study

Lee, Ji-Hyun MD1; Jang, Young-Eun MD1; Song, In-Kyung MD2; Kim, Eun-Hee MD1; Kim, Hee-Soo MD, PhD1; Kim, Jin-Tae MD, PhD1

Pediatric Critical Care Medicine: January 2018 - Volume 19 - Issue 1 - p 32-39
doi: 10.1097/PCC.0000000000001386
Cardiac Intensive Care
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Objectives: This study is designed to determine the feasibility and utility of vascular occlusion test variables as measured by INVOS (Medtronic, Dublin, Ireland) in pediatric cardiac patients.

Design: A prospective observational study.

Setting: A tertiary children’s hospital.

Patients: Children less than or equal to 8 years old who were scheduled for elective cardiac surgery under cardiopulmonary bypass.

Interventions: A vascular occlusion test (3 min of ischemia and reperfusion) was performed on the calf at three time points: after induction of anesthesia (T0), during cardiopulmonary bypass (T1), and after sternal closure (T2).

Measurements and Main Results: Baseline regional tissue hemoglobin oxygen saturation, deoxygenation rate, minimum regional tissue hemoglobin oxygen saturation, and reoxygenation rate were measured using INVOS. Influence of age on variables at each measurement point was also checked using linear regression analysis. Receiver operating characteristics curve analysis was performed to determine the ability of vascular occlusion test variables at T2 to predict the occurrence of major adverse events. Both the deoxygenation and reoxygenation rates were lowest in T1. There was a tendency to decreased regional tissue hemoglobin oxygen saturation in younger patients at T0 (r = 0.37; p < 0.001), T1 (r = 0.33; p < 0.001), and T2 (r = 0.42; p < 0.001) during vascular occlusion. Minimum regional tissue hemoglobin oxygen saturation was correlated with age at T0 (r = 0.51; p < 0.001) and T2 (r = 0.35; p = 0.001). Patients with major adverse events had similar baseline regional tissue hemoglobin oxygen saturation but lower minimum regional tissue hemoglobin oxygen saturation (48.8% ± 19.3% vs 63.3% ± 13.9%; p < 0.001) and higher reoxygenation rate (4.30 ± 3.20 vs 2.57 ± 2.39 %/s; p = 0.008) at T2 compared with those without. The minimum regional tissue hemoglobin oxygen saturation less than 51% after sternal closure could predict the occurrence of major adverse events with a sensitivity of 61.1% and a specificity of 85.4%.

Conclusions: Vascular occlusion test using INVOS can be applied in children undergoing cardiac surgery. Vascular occlusion test variables are influenced by age and cardiopulmonary bypass. The minimum regional tissue hemoglobin oxygen saturation less than 51% after sternal closure is associated with worse clinical outcomes in pediatric cardiac patients.

1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.

2Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Drs. Lee and Jang contributed equally.

Trial registration: https://www.clinicaltrials.gov/ct2/show/NCT02287753?term=NCT02287753&rank=1 (number: NCT02287753; principal investigator: Dr. Kim).

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: Jintae73@gmail.com

Copyright © 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies