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Near-infrared spectroscopy in neonates before palliation of hypoplastic left heart syndrome. Ann Thorac Surg 2009 Feb;87(2):571-7; discussion 577-9

Date

01/24/2009

Pubmed ID

19161781

DOI

10.1016/j.athoracsur.2008.10.043

Scopus ID

2-s2.0-58249137786   79 Citations

Abstract

BACKGROUND: Neonates with hypoplastic left heart syndrome have circulatory vulnerability that results in shock and high risk of mortality without intervention. High arterial saturation (SaO(2)) is often used as a proxy for inadequate systemic oxygen delivery and triggers the use of invasive therapies to restore circulatory balance. We hypothesized that preoperative use of near-infrared spectroscopy (NIRS) would reduce the need for invasive therapies, including controlled ventilation and inspired gas manipulation.

METHODS: A Human Research Review Board-approved retrospective review of patients who had stage 1 palliation from January 2000 to January 2006 was conducted. Preoperative patient characteristics, cardiorespiratory support, and monitored data were collected for all patients. Cerebral and somatic tissue oxyhemoglobin saturations were recorded for patients with preoperative NIRS monitoring.

RESULTS: The studied cohort included 92 patients, 47 without and 45 with preoperative NIRS. Patient characteristics were similar between groups. Differences were observed in preoperative respiratory support. Controlled ventilation was less common in the NIRS group (51% versus 79%, p = 0.005) as was the use of inspired nitrogen (16% versus 70%, p = 0.001). The NIRS patients had higher mean SaO(2) (92% versus 88%, p = 0.001). Age at surgery was similar between groups (5.7 +/- 3.2 versus 6.5 +/- 5.2 days, p = 0.3). Early survival was 96% in each group.

CONCLUSIONS: Near-infrared spectroscopy monitoring of patients with hypoplastic left heart syndrome awaiting palliation provides noninvasive assessment of oxygen delivery and simplified management, with reduced use of controlled ventilation and inspired gas. Higher SaO(2) in the NIRS group was not associated with impaired systemic oxygen delivery, and did not lead to earlier palliation or postoperative mortality.

Author List

Johnson BA, Hoffman GM, Tweddell JS, Cava JR, Basir M, Mitchell ME, Scanlon MC, Mussatto KA, Ghanayem NS

Authors

Mir Abdul Basir MD Professor in the Pediatrics department at Medical College of Wisconsin
Joseph R. Cava MD, PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin
George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Kathleen Mussatto Ph.D. Associate Professor in the School of Nursing department at Milwaukee School of Engineering
Matthew C. Scanlon MD Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Cardiac Surgical Procedures
Cause of Death
Cohort Studies
Female
Follow-Up Studies
Humans
Hypoplastic Left Heart Syndrome
Infant, Newborn
Male
Monitoring, Physiologic
Palliative Care
Preoperative Care
Probability
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Spectroscopy, Near-Infrared
Survival Rate
Time Factors