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Volume 3 Supplement 1

ESICM LIVES 2015

Cerebral and somatic oxygen saturation in pediatric cardiac patients with delayed sternal closure

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Introduction

Near-infrared spectroscopy offers non-invasive online monitoring of tissue oxygenation in a wide range of clinical scenarios.

Objectives

The purpose of this study was to assess near-infrared spectroscopy-derived cerebral and somatic oxygen saturations (rSO2b and rSO2s) in children after cardiac surgery with delayed sternal closure (DSC). We hypothesized that rSO2b and rSO2s correlate with other indicators of hemodynamic compromise after DSC.

Methods

We studied 43 postoperative children (median age, 8 days; range, 1-148 days) with DSC. The most common cardiac diagnosis was hypoplastic left heart syndrome (30%). rSO2b and rSO2s and other hemodynamic and metabolic parameters were analyzed on the day of surgery, 3 days after surgery (POD1-3), and prior to and 24 hours after DSC.

Results

rSO2b increased at 12 hours (p = 0.0039), and rSO2s did not change compared to data immediately after surgery. Deficit base decreased (p = 0.016) and standard bicarbonates increased (p = 0.016) on POD1, lactate decreased (p = 0.0001) and diuresis increased (p = 0.013) on POD2, heart rate decreased (p = 0.035) on POD3. There was no change in systemic arterial blood pressure, left atrial pressure (LAP) and central venous pressure (CVP), arteriovenous oxygen saturation difference (a-vO2 dif.), pH, paO2, and paCO2. Vasoactive inotropic score was lower on POD2 and 3 compared to the day of surgery (p = 0.041 and p = 0.048). DSC resulted in an increase in LAP, CVP, a-vO2 dif., and base deficit (p < 0.05). Increase in LAP lasted 24 hours, other changes were present during 18 hours. rSO2b and rSO2s were lower at 1 - 6 hour and during 24 hours, respectively (p < 0.05). There was no change in lactate levels. pH and standard bicarbonate were lower and vasoactive inotropic score was higher compared to preclosure values (p < 0.05). rSO2b and rSO2s values did not correlate with lactate and a-vO2 dif. values.

Conclusions

In pediatric cardiac patients with left open chest rSO2b values increase on the day of surgery and rSO2s do not change. DSC is associated with a decrease in rSO2b and rSO2s that persists for 6 and 24 hours, respectively. rSO2b and rSO2s values do not correlate with other metabolic indicators of hemodynamic status.

References

  1. 1.

    Özker E, Saritaş B, Vuran C, et al: Delayed Sternal Closure After Pediatric Cardiac Operations; Single Center Experience: a Retrospective Study. J Thorac Cardiovasc Surg. 2012, 7: 102-

  2. 2.

    Horvath R, Shore S, Schultz SE, et al: Cerebral and somatic oxygen saturation decrease after delayed sternal closure in children after cardiac surgery. J Thorac Cardiovasc Surg. 2010, 139: 894-900. 10.1016/j.jtcvs.2009.06.013.

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Author information

Correspondence to L Kovacikova.

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Kovacikova, L., Bicianova, A., Skrak, P. et al. Cerebral and somatic oxygen saturation in pediatric cardiac patients with delayed sternal closure. ICMx 3, A950 (2015) doi:10.1186/2197-425X-3-S1-A950

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Keywords

  • Central Venous Pressure
  • Hypoplastic Left Heart Syndrome
  • Leave Atrial Pressure
  • Base Deficit
  • Hemodynamic Compromise