Cerebral tissue oxygenation index and lactate at 24 hours postoperative predict survival and neurodevelopmental outcome after neonatal cardiac surgery

Aly, Safwat; Zurakowski, David; Glass, Penny; Skurow-Todd, Kami; Jonas, Richard A.; Donofrio, Mary T.

doi:10.1111/chd.12426

Cited by 51 publications

(61 citation statements)

References 36 publications

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“…Cerebral NIRS has been proposed as an indicator of perfusion, and lower cerebral NIRS values have been associated with poorer outcomes in some pediatric surgeries. [27][28][29] Lumbar NIRS during kidney transplantation is a recently proposed use for this technology and appears to correlate with markers of graft function and perfusion. 30 Many patients come to the operating room with a dialysis cath- Another interesting finding of the current survey is the ongo- despite a delayed recovery of renal function after deceased donor kidney transplantation in children.…”

Section: Discussionmentioning

confidence: 99%

A survey of the anesthetic management of pediatric kidney transplantation in France

Marsac

Michelet

Sola

et al. 2019

Pediatric Transplantation

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Background Renal transplantation is the best available therapeutic option for end‐stage renal failure in both children and adults. However, little is known about anesthetic practice during pediatric renal transplantation. Material and Methods The study consisted of a national survey about anesthetic practice during pediatric renal transplantation in France. French tertiary pediatric centers performing renal transplants were targeted, and one physician from each team was asked to complete the survey. The survey included patient data, preoperative assessment and optimization data, and intraoperative anesthesia data (drugs, ventilation, and hemodynamic interventions). Results Twenty centers performing kidney transplantation were identified and contacted to complete the survey, and eight responded. Surveyed centers performed 96 of the 122 pediatric kidney transplantations performed in France in 2017 (79%). Centers consistently performed echocardiography and ultrasound examinations of the great veins preoperatively and consistently employed esophageal Doppler cardiac output estimation and vasopressors intraoperatively. All other practices were found to be heterogeneous. Central venous pressure was monitored in six centers, and dopamine was administered perioperatively in two centers. Conclusions The current study provides a snapshot of the perioperative management of pediatric kidney transplantation in France. Results emphasize the need for both standardization of practice and awareness of recent evidence against the use of CVP monitoring and dopamine infusions.

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Section: Discussionmentioning

confidence: 99%

A survey of the anesthetic management of pediatric kidney transplantation in France

Marsac

Michelet

Sola

et al. 2019

Pediatric Transplantation

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“…Therefore, the interest in lactate in relation to the cerebral oxygenation in the neonatal period increased in the last years. Eighteen studies were identified, which investigated cerebral oxygenation and blood lactate level in neonates (7,11,13,15,16,18,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). However, only one of these publications demonstrated a negative association between cerebral oxygenation and lactate (7), and three studies found no association (11,23,29) between these factors.…”

Section: Lactate Level and Cerebral Oxygenationmentioning

confidence: 99%

Blood Glucose and Lactate Levels and Cerebral Oxygenation in Preterm and Term Neonates—A Systematic Qualitative Review of the Literature

et al. 2020

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Background: Cerebral oxygenation monitored non-invasively by near-infrared spectroscopy (NIRS) is of increasing interest in neonatal care. Cerebral oxygenation is determined by cerebral oxygen delivery and cerebral oxygen consumption. Oxygen delivery as well as oxygen consumption might be influenced by metabolic parameters like blood glucose and lactate. Objective: The aim of the present systematic qualitative review is therefore to identify and summarize all studies, which describe cerebral oxygenation measured with NIRS and blood glucose and/or blood lactate levels in neonates. Data sources: A systematic search of Ovid Embase and PubMed was performed. Search terms included near-infrared spectroscopy, fractional tissue oxygen extraction, cerebral tissue oxygen saturation, regional cerebral tissue oxygen saturation, oxygenation, term, and preterm neonates, cesarean delivery, transition, after-birth, newborn, vaginal delivery, cesarean delivery, baby, neonatal transition, metabolism, lactate, glucose, and blood glucose level. Study selection/data synthesis: Studies analyzing cerebral oxygenation and blood glucose and/or blood lactate levels in neonates were included. Animal studies, duplicates, or studies in non-English language were excluded. Results: Twenty-five studies were identified that describe blood glucose and/or blood lactate levels as primary or secondary outcome parameters with additional measured cerebral oxygenation by NIRS in neonates. Twelve studies were included with blood glucose measurements: four described an association between blood glucose levels and cerebral oxygenation, two show no association, and six do not report on possible associations. Eighteen studies were included with lactate measurements: one describe an association between lactate levels and cerebral oxygenation, while three show no association and 14 do not report on possible associations.

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“…Postoperative lactate levels and derived variables have been described as an early outcome predictor, particularly of survival but also for developmental outcome in children with CHD undergoing repair or palliation with cardiopulmonary bypass. 24,46,47…”

Section: Association Between S100b and Routine Monitoring Datamentioning

confidence: 99%

S100B and its relation to cerebral oxygenation in neonates and infants undergoing surgery for congenital heart disease

Hansen

Kissner

Logoteta

et al. 2019

Congenital Heart Disease

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Objectives: Neonates and infants undergoing surgery for congenital heart disease are at risk for developmental impairment. Hypoxic-ischemic brain injury might be one contributing factor. We aimed to investigate the perioperative release of the astrocyte protein S100B and its relation to cerebral oxygenation.Methods: Serum S100B was measured before and 0, 12, 24, and 48 hours after surgery. Cerebral oxygen saturation was derived by near-infrared spectroscopy. S100B reference values based on preoperative samples; concentrations above the 75th percentile were defined as elevated. Patients with elevated S100B at 24 or 48 hours were compared to cases with S100B in the normal range. Neonates (≤28 days) and infants (>28 and ≤365 days) were analyzed separately due to age-dependent release of S100B.Results: Seventy-four patients underwent 94 surgical procedures (neonates, n = 38;infants, n = 56). S100B concentrations were higher in neonates before and after surgery at all time points (P ≤ .015). Highest values were noticed immediately after surgery. Postoperative S100B was elevated after 15 (40.5%) surgeries in neonates.There was no difference in pre-, intra-, or postoperative cerebral oxygenation. In infants, postoperative S100B was elevated after 23 (41.8%) procedures. Preoperative cerebral oxygen saturations tended to be lower (53 ± 12% vs 59 ± 12%, P = .069) and arterial-cerebral oxygen saturation difference was higher (35 ± 11% vs 28 ± 11%, P = .018) in infants with elevated postoperative S100B. In the early postoperative course, cerebral oxygen saturation was lower (54 ± 13% vs 63 ± 12%, P = .011) and arterial-cerebral oxygen saturation difference was wider (38 ± 11% vs 30 ± 10%, P = .008). Cerebral oxygen saturation was also lower for the entire postoperative course (62 ± 18% vs 67 ± 9%, P = .047). Conclusions:Postoperative S100B was elevated in about 40% of neonates and infants undergoing cardiac surgery. Infants with elevated postoperative S100B had impaired perioperative cerebral tissue oxygenation. No relation between S100B and cerebral oxygenation could be demonstrated in neonates. K E Y W O R D Sbrain biomarkers, cardiopulmonary bypass, cerebral protection, near-infrared spectroscopy

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Cerebral tissue oxygenation index and lactate at 24 hours postoperative predict survival and neurodevelopmental outcome after neonatal cardiac surgery

Abstract: Cerebral TOI combined with lactate at 24 hours postoperative are accurate non-invasive predictive biomarkers of patient survival and neurodevelopmental outcome in neonates with CHD undergoing cardiac surgery.

Cited by 51 publications

References 36 publications

A survey of the anesthetic management of pediatric kidney transplantation in France

A survey of the anesthetic management of pediatric kidney transplantation in France

Blood Glucose and Lactate Levels and Cerebral Oxygenation in Preterm and Term Neonates—A Systematic Qualitative Review of the Literature

S100B and its relation to cerebral oxygenation in neonates and infants undergoing surgery for congenital heart disease

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