Cerebral NIRS as a marker of superior vena cava oxygen saturation in neonates with congenital heart disease

Zaccaria Ricci (1) , Cristiana Garisto (2) , Isabella Favia (2) , Ulrike Schloderer (2) , Chiara Giorni (2) , Tiziana Fragasso (2) , Sergio Picardo (2)

1 Department of pediatric cardiac surgery
2 Department of pediatric cardiac surgery

Objectives: to investigate the correlation between cerebral NIRS (rSO2c) and superior vena cava venous oxygen saturation (ScvO2) in newborn patients with congenital heart disease (CHD). Background: Near infrared spectroscopy (NIRS) is a non invasive method to monitor hemoglobin oxygen saturation using non pulsatile oximetry. Methods: We retrospectively analyzed perioperative data from 100 newborn patients who underwent cardiac surgery for CHD. RSO2c, ScvO2 from 24 hours before to 72 hours after surgery were recorded. Results: rSO2c had a fair correlation with ScvO2 (r 0,37; p<0.001). The relationship between rSO2c and ScvO2 did not change when analyzed between patients with cyanotic or acyanotic CHD. During the preoperative period rSO2c levels overestimated ScvO2; in the first 18 postoperative hours rSO2c understimated ScvO2; after that period they showed very close trends. Hypocapnia caused rSO2c to underestimate ScvO2; in normocapnic patients rSO2c-ScvO2 average differences were close to zero; in hypercapnic neonates rSO2c tended to overestimate ScvO2. The best performance of rSO2c as a surrogate of ScvO2 was found in the venous saturation ranges from 40 to 60% (r 0.3, p: 0.03). Conclusions: rSO2c in newborn patients with cyanotic and acyanotic CHD provides a continuous non invasive information with a fair correlation with ScvO2 %: some predictable variables (i.e. time from surgery, carbon dioxide and venous saturation levels), should guide the operators in order to adjust rSO2c values in terms of ScvO2. Serial measures of ScvO2 seem recommended in order to tailor rSO2c information on actual venous saturation percentage.

Mots clés: Medicine

Zaccaria Ricci, Cristiana Garisto, Isabella Favia, Ulrike Schloderer, Chiara Giorni, et al.. Cerebral NIRS as a marker of superior vena cava oxygen saturation in neonates with congenital heart disease. Pediatric Anesthesia, 2010, 20 (11), pp.1040. ⟨10.1111/j.1460-9592.2010.03430.x⟩. ⟨hal-00587983⟩