Evaluation of Pediatric Near-Infrared Cerebral Oximeter for Cardiac Disease

Kreeger, Renee Nierman; Ramamoorthy, Chandra; Nicolson, Susan C.; Ames, Warwick A.; Hirsch, Russel; Peng, Lynn F.; Glatz, Andrew C.; Hill, Kevin D.; Hoffman, Joan; Tomasson, Jon; Kurth, C. Dean

doi:10.1016/j.athoracsur.2012.05.096

Cited by 44 publications

(34 citation statements)

References 19 publications

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“…36 By Bland-Altman analysis (Figure 2) the mean bias and precision (±1SD) was 1.2% and 4.6%, respectively, with confidence intervals around the limits of agreement of 11.0% and −9.6%. Our findings are similar to that reported by Kreeger et al 37 , and despite the wide confidence intervals around the limits of agreement, the precision still allows for discrimination between normal ScO 2 levels and those associated with cerebral hypoxia-ischemia. 33 …”

Section: Discussionsupporting

confidence: 92%

Cerebral Oxygen Saturation in Children With Congenital Heart Disease and Chronic Hypoxemia

Kussman

Laussen

Benni

et al. 2017

Anesthesia &Amp; Analgesia

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Background Increased Hb concentration accompanying hypoxemia is a compensatory response to maintain tissue oxygen delivery (DO2). Near infrared spectroscopy (NIRS) is used clinically to detect abnormalities in the balance of cerebral DO2 and consumption, including in children with congenital heart disease (CHD). Although NIRS-measured cerebral tissue O2 saturation (ScO2) correlates with SaO2, jugular bulb O2 saturation (SjbO2), and Hb, little data exists on the interplay between these factors and cerebral O2 extraction (COE). This study investigated the associations of ScO2 and ΔSaO2–ScO2 with SaO2 and Hb and verified the normal range of ScO2 in children with CHD. Methods Children undergoing cardiac catheterization for CHD were enrolled in a calibration and validation study of the FORE-SIGHT® NIRS monitor. Two pairs of simultaneous arterial and jugular bulb samples were drawn for co-oximetry, calculation of a reference ScO2 (REF CX), and estimation of COE. Pearson correlation and linear regression were used to determine relationships between O2 saturation parameters and Hb. Data were also analyzed according to diagnostic group defined as acyanotic (SaO2 ≥ 90%) and cyanotic (SaO2 < 90%). Results Of 65 children studied, acceptable jugular bulb samples (SjbO2 absolute difference between samples ≤ 10%) were obtained in 57 (88%). The ΔSaO2–SjbO2, ΔSaO2–ScO2, and ΔSaO2−REF CX were positively correlated with SaO2 and negatively correlated with Hb (all P < 0.001). Although by diagnostic group ScO2 differed statistically (P = 0.002), values in the cyanotic patients were within the range considered normal (69 ± 6%). COE estimated by the difference between arterial and jugular bulb O2 content (ΔCaO2−CjbO2, mL O2/100 mL) was not different for cyanotic and acyanotic patients (P = 0.10), but estimates using ΔSaO2–SjbO2, ΔSaO2–ScO2, or ΔSaO2–ScO2/SaO2 were significantly different between the cyanotic and acyanotic children (P < 0.001). Conclusions Children with adequately compensated chronic hypoxemia appear to have ScO2 values within the normal range. The ΔSaO2–ScO2 is inversely related to Hb, with the implication that in the presence of reduced Hb, particularly if coupled with a decreased cardiac output, the ScO2 can fall to values associated with brain injury in laboratory studies.

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Section: Discussionsupporting

confidence: 92%

Cerebral Oxygen Saturation in Children With Congenital Heart Disease and Chronic Hypoxemia

Kussman

Laussen

Benni

et al. 2017

Anesthesia &Amp; Analgesia

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“…27,28,29 The significance of the cerebral oximeter can be further demonstrated by substituting equation 3 (assuming blood distribution to be 70% venous (Kv = 0.7), 30% arterial (Ka = 0.3), and negligible amount in the capillaries (Kc = 0) and ERROR assumed to be zero for the ideal case as suggested by Ito et al 11 ) into equation 6 and solving the ratio of CMRO 2 to CBF as a function of S ct O 2 (equation 7).

normalC normalM normalR O_{2} / normalC normalB normalF = false(S_{p} O_{2} - S_{normalc normalt} O_{2} false) \times normalK 1 + normalK 2

Where K1 = (1.34 × [tHb]) /0.7

And

K2 = 0.003 × (P a O 2 − P jb O 2 ).

Solving equation 7 for S ct O 2 then becomes (equation 8):

S_{normalc normalt} O_{2} = S_{p} O_{2} + false(normalK 2 - normalC normalM normalR O_{2} / normalC normalB normalF false) / normalK 1

From this equation, it can be deduced that the S ct O 2 has a proportional relationship to S p O 2 and CMRO 2 and inversely proportional with CBF.…”

Section: Discussionmentioning

confidence: 99%

The Accuracy of a Near-Infrared Spectroscopy Cerebral Oximetry Device and Its Potential Value for Estimating Jugular Venous Oxygen Saturation

Ikeda

MacLeod

Grocott

et al. 2014

Anesthesia &Amp; Analgesia

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Background An intriguing potential clinical use of cerebral oximeter measurements (SctO2) is the ability to noninvasively estimate jugular bulb venous oxygen saturation (SjvO2). Our purpose in this study was to determine the accuracy of the FORE-SIGHT® (CAS Medical Systems; Branford, CT), which is calibrated to a weighted average of 70% (SjvO2) and 30% arterial saturation, for Food and Drug Administration pre-market approval 510 (k) certification by adapting an industry standard protocol, ISO 9919:2005 [www.ISO.org] (used for pulse oximeters) and to evaluate the use of SctO2 and SpO2 measurements to noninvasively estimate jugular venous oxygen saturation (SnvO2). Methods Paired blood gas samples from the radial artery and the jugular venous bulb were collected from 20 healthy volunteers undergoing progressive oxygen desaturation from 100 to 70%. The blood sample pairs were analyzed via co-oximetry and used to calculate the approximate mixed vascular cerebral blood oxygen saturation, or reference SctO2 values (refSctO2), during increasing hypoxia. These reference values were compared to bilateral FORE-SIGHT SctO2 values recorded simultaneously with the blood gas draws to determine its accuracy. Bilateral SctO2 and SpO2 measurements were then used to calculate SnvO2 values which were compared to SjvO2. Results Two hundred forty-six arterial and 253 venous samples from 18 subjects were used in the analysis. The ipsilateral FORE-SIGHT SctO2 values showed a tolerance interval (TI) of [−10.72 10.90] Lin’s concordance correlation coefficient (CCC) with standard error (SE) of 0.83 ± 0.073 with the refSctO2 values calculated using arterial and venous blood gases. The combined data had a CCC of 0. 81 + 0.059 with TI of [−9.22 9.40] with overall bias was 0.09% and amplitude of the root mean square of error after it was corrected with random effects analysis was 2.92%. The bias and variability values between the ipsilateral and the contralateral FORE-SIGHT SctO2 measurements varied from person to person. The SnvO2 calculated from the ipsilateral SctO2 and SpO2 data showed a CCC + SE of 0.79 ± 0.088, TI = [−14.93 15.33], slope of 0.98, Y-Intercept of 1.14%) with SjvO2 values with a bias of 0.20% and an Arms of 4.08%. The SnvO2 values calculated independently from contralateral forehead FORE-SIGHT SctO2 values were not as correlated with the SjvO2 values (contralateral side CCC + SE = 0.72 ± 0.118, TI = [−14.86 15.20], slope of 0.66 and y-intercept of 20.36%). Conclusions The FORE-SIGHT cerebral oximeter was able to estimate oxygen saturation within the tissues of the frontal lobe under conditions of normocapnia and varying degrees of hypoxia (with 95% confidence interval of [−5.60 5.78] with ipsilateral blood ample data). These findings from healthy volunteers also suggest that the use of the calculated SnvO2 derived from SctO2 and SpO2 values may be a reasonable noninvasive method of estimating SjvO2 and therefore global cerebral oxygen consumption in the clinical setting. Further laboratory and clinical research is ...

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“…The Fore‐Sight and Equanox – and for that reason the SenSmart, because the company states that both devices are based on the same technology – are sold as devices for measuring absolute tissue saturation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of four near‐infrared spectroscopy devices shows that they are only suitable for monitoring cerebral oxygenation trends in preterm infants

et al. 2014

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Evaluation of Pediatric Near-Infrared Cerebral Oximeter for Cardiac Disease

Cited by 44 publications

References 19 publications

Cerebral Oxygen Saturation in Children With Congenital Heart Disease and Chronic Hypoxemia

Cerebral Oxygen Saturation in Children With Congenital Heart Disease and Chronic Hypoxemia

The Accuracy of a Near-Infrared Spectroscopy Cerebral Oximetry Device and Its Potential Value for Estimating Jugular Venous Oxygen Saturation

Comparison of four near‐infrared spectroscopy devices shows that they are only suitable for monitoring cerebral oxygenation trends in preterm infants

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