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Volume 3 Supplement 1

ESICM LIVES 2015

  • Poster presentation
  • Open Access

The value of the fore-sightTM monitor in the postoperative phase after congenital cardiac surgery. a descriptive statistical interim-analysis

  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Intensive Care Medicine Experimental20153 (Suppl 1) :A595

https://doi.org/10.1186/2197-425X-3-S1-A595

  • Published:

Keywords

  • Oxygen Saturation
  • Paediatric Intensive Care Unit
  • Postoperative Phase
  • Central Venous Oxygen Saturation
  • Brain Tissue Oxygenation

Introduction

The FORE-SIGHTTM monitor measures absolute cerebral tissue oxygen saturation (SctO2) of the frontal lobes of the brain, in a non-invasive way, through near-infrared spectroscopy (NIRS) [1]. Its value for early detection of hemodynamic deterioration in the postoperative phase after congenital cardiac surgery has never been examined. In a prospective observational study [2], 300 mechanically ventilated patients younger than 12 years after cardiac surgery will be monitored with NIRS, in addition to their routine haemodynamic monitoring. The NIRS monitor is blinded to clinicians, and its predictive value to detect predefined critical hemodynamic events will be analysed.

Objectives

To compare SctO2 in relationship to the arterial oxygen saturation (SaO2) and central venous oxygen saturations (ScvO2), in children with cyanotic (CC) and non-cyanotic cardiopathy (NCC) admitted to the paediatric intensive care unit (PICU) after congenital cardiac surgery.

Methods

The present study is a preliminary report of baseline data and monitored values of the first 136 children included in the abovementioned prospective observational FORE-SIGHTTM study.

Results

The results are summarized in table 1 and table 2. 83 children were admitted with a CC, 53 with NCC, and 57.3% were boys. Patients in the CC-subgroup had a longer median PICU length of stay, had lower mean arterial blood pressures, and higher haemoglobin levels compared to patients in the NCC-subgroup. Evidently, CC-patients had a lower mean SaO2. There was a non-significant trend towards lower ScvO2 and SctO2 values in the CC subgroup (which was significant for L- SctO2). ScvO2 was significantly lower than SctO2 in the CC-subgroup (p=0.002), but not in the NCC-subgroup (p=0.28).

Table 1

 

Overall

Cyanogenic

Non-Cyanogenic

p-value (*)

Number (boy/girl ratio)

136 (57.3%)

83 (56.6%)

53 (58.5%)

 

Age in months: median (IQR)

5.5 (2-18.5)

5 (2-19.8)

6 (2-17)

0.61

PICU LOS in days: median (IQR)

5 (3-9)

6 (4-12)

3 (2-6)

0.0004

Hemoglobin (g/dl)

10.9 (1.2)

11.1 (1.2)

10.5 (1.1)

0.005

Mean arterial pressure (mmHg)

63.7 (9.6)

61.7 (9.5)

66.8 (9.1)

0.003

Mean and SD was reported, except for age and ICU LOS. (*) P-value of the comparison of the cyanogenic and non-cyanogenic groups. T-test was used to compare means, Wilcoxon ranking-test for medians.

Table 2

 

Overall

Cyanogenic

Non-Cyanogenic

p-value (*)

SaO2 (%)

92.7 (7.4)

90.7 (8.0)

95.7 (4.9)

< <0.0001

ScvO2 (%)

67.3 (12.7)

65.5 (11.9)

70.8 (13.7)

0.07

L-SctO2 (%)

71.6 (7.2)

70.6 (7.8)

73.1 (5.9)

0.04

R-SctO2 (%)

71.3 (6.9)

70.5 (7.7)

72.6 (5.2)

0.08

A-SctO2 (%)

71.7 (6.5)

70.8 (7.3)

73.1 (4.8)

0.06

ScvO2 < A-SctO2

 

p=0.002

p = 0.28

 

Mean and SD was reported, except for age and ICU LOS. (*) P-value of the comparison of the cyanogenic and non-cyanogenic groups. T-test was used to compare means, Wilcoxon ranking-test for medians.

Conclusions

Notwithstanding the lower observed SaO2, CC patients are able to preserve brain tissue oxygenation as measured by NIRS, which is significantly higher than their ScvO2. The additional predictive value of NIRS in this setting will be assessed in the ongoing Fore-sight study.

Trial Registration

Clinical trial registered with www.clinicaltrials.gov (NCT01706497).

Grant Acknowledgment

Foundation for Scientific Research Flanders (FWO) (G. 0904.11). Senior clinical investigator, FWO to Geert Meyfroidt (1846113N). Methusalem program, Flemish Government to Greet Van den Berghe (METH/08/07).

Authors’ Affiliations

(1)
Intensive Care, KU Leuven, Leuven, Belgium

References

  1. Fisher GW, Silvay G: Cerebral oximetry in cardiac and major vascular surgery. HSR Proc Intensive Care Cardiovasc Anesth. 2010, 2 (4): 249-256.Google Scholar

Copyright

© Delrue et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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