Noninvasive monitoring of venous oxygen saturation by transcutaneous near-infrared spectroscopy in pediatric patients undergoing congenital cardiac surgery.

Altun, Dilek; Doğan, Abdullah; Arnaz, Ahmet; Yüksek, Adnan; Yalçinbaş, Yusuf Kenan; Türköz, Riza; Sarioğlu, Cafer Tayyar

BACKGROUND AND AIM In patients undergoing congenital cardiac surgery, it is crucial to maintain oxygen demand-consumption balance. Central venous oxygen saturation (ScvO2) is a useful indicator of oxygen demand and consumption balance which is an invasive method. Near-infrared spectroscopy (NIRS) is a noninvasive, continuous monitoring technique that measures regional tissue oxygenation. NIRS that is placed over the internal jugular vein cutaneous area (NIRSijv) has the potential to show ScvO2 indirectly. In this study, we aimed to determine the correlation between ScvO2 with NIRSijv in pediatric patients undergoing congenital cardiac surgery. MATERIALS AND METHODS Fifty children participated in the study. Four patients were excluded for the inability of internal jugular vein (IJV) catheterization due to technical difficulties. After anesthesia induction, NIRS probes were placed on the IJV site with ultrasound guidance for the measurement of continuous transcutaneous oxygen saturation. The catheter insertion was also done through the IJV from the other side using ultrasound guidance. Cerebral oxygenation monitoring was done using NIRS with a single pediatric probe placed on the right forehead. Values of NIRSijv, cerebral NIRS (NIRSc) and ScvO2, were recorded at certain times until postoperative 24th hour. RESULTS Data were collected at 8 different time points. There was a significant correlation between ScvO2 and NIRSijv in all measurement time points (r = 0.91), (p = 0.001). The mean bias between ScvO2 and NIRSijv was 2.92% and the limits of agreement were 11 to -5.2%. There was a moderate correlation between ScvO2 and NIRSc (r = 0.45), (p = 0.001). The mean bias between ScvO2 and NIRSc was 2.7% and the limits of agreement were +26 to -20%. CONCLUSION In this study, we found a strong correlation between ScvO2 and NIRS measurements taken from the internal jugular vein site. Accordingly, continuous noninvasive monitoring with transcutaneous NIRSijv can be an alternative method as a trend monitor for the central venous oxygen saturation in pediatric cardiac patients undergoing congenital cardiac surgery.