Non-invasive assessment of cerebral oxygen metabolism following surgery of congenital heart disease

Neunhoeffer, Felix; Sandner, Katharina; Wiest, Milena; Haller, Christoph; Renk, Hanna; Kumpf, Matthias; Schlensak, Christian; Hofbeck, Michael

doi:10.1093/icvts/ivx080

Cited by 6 publications

(3 citation statements)

References 30 publications

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“…Parameters of cerebral oxygen saturation and cerebral perfusion were recorded continuously during surgery with a device combining laser Doppler flowmetry and white light spectrometry called “Oxygen‐to‐See” (O 2 C). The technology of this device has been described in detail in previous studies 6–10 . Measurements were performed with a flat probe (LF‐3‐023 O 2 C, type LF‐3; probe head: width 15 mm, height 5.5 mm, length 44.5 mm; probe length 300 cm Oxygen‐to‐See; LEA Medizintechnik, Giessen, Germany) which was placed over the right forehead offering a sampling depth of 15 mm 11 .…”

Section: Methodsmentioning

confidence: 99%

“…The technology of this device has been described in detail in previous studies. [6][7][8][9][10] Measurements were performed with a flat probe (LF-3-023 O 2 C, type LF-3; probe head: width 15 mm, height 5.5 mm, length 44.5 mm; probe length 300 cm Oxygen-to-See; LEA Medizintechnik, Giessen, Germany) which was placed over the right forehead offering a sampling depth of 15 mm. 11 The probe transmits white light (500-800 nm, 1 nm resolution, <30 mW) into the tissue and recollects the reflected light.…”

Section: Materials S and Me Thodsmentioning

confidence: 99%

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The effect of intraoperative cerebral oxygen desaturations on postoperative cerebral oxygen metabolism in neonates and infants a pilot study

Jock,

Neunhoeffer,

Rörden

et al. 2023

Pediatric Anesthesia

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IntroductionCerebral oxygen desaturation during pediatric surgery has been associated with adverse perioperative outcomes. The aim of this pilot study was to analyze the frequency and severity of intraoperative cerebral oxygen desaturations and their impact on postoperative cerebral oxygen metabolism in neonates and infants undergoing pediatric surgery.MethodsIn a prospective pilot study, intra‐ and postoperative regional cerebral oxygen saturation and blood flow were measured noninvasively using a device combining laser Doppler flowmetry and white‐light‐spectrometry. Thirty‐seven consecutive neonates and infants undergoing noncardiac surgery under general anesthesia for more than 30 min and necessity for invasive arterial blood pressure monitoring were included. Patients with pre‐known congenital structural heart disease or cerebral disease were excluded. Continuously brain monitor recording was started in sedated patients before induction of anesthesia (preoperative baseline) and was completed 1 h postoperatively in the PICU in sedated, intubated, and mechanically ventilated states at the PICU (postoperative state). Baseline and postoperative state for cerebral fractional tissue oxygen extraction and approximated cerebral metabolic rate of oxygen were calculated.ResultsSeventeen (46%) of the 37 studied neonates and infants suffered from intraoperative periods of regional cerebral oxygen desaturation below 20% of the baseline (event group). Severity of cerebral desaturations was median 4.0%min/h [range 0.1–58.7; interquartile range [IQR] 0.99–21.29]. In the event group, the duration of surgery was significantly longer (median 135 min [range 11–260; IQR 113.5–167.0] vs median 46.5 min [range 11–180; IQR 30.5–159.3]; difference of −62.94; 95% confidence interval [CI] −105.17 to −20.71; p = .021). In the event group, cerebral fractional tissue oxygen extraction (median 0.41 [range 0.20–0.55; IQR 0.26–0.44] vs. median 0.27 [range 0.11–0.41; IQR 0.20–0.31]; difference of −0.11; 95% CI −0.17 to −0.05; p = .001) and approximated cerebral metabolic rate of oxygen (median 6.15 arbitrary unit [range 2.69–12.07; IQR 5.12–7.21] vs. median 4.14 arbitrary unit [range 1.78–7.86; IQR 3.82–6.31]; difference of −1.76; 95% CI −3.03 to −0.49; p = .009) were significantly higher and the cerebral regional oxygen saturation (median 58.99% [range 44.87–79.1; IQR 54.26–72.61] vs median 70.94% [range 57.9–86.13; IQR 67.07–76.59]; difference of 10.01; 95% CI 4.13–15.90; p = .002) significantly lower after surgery compared to the nonevent group.DiscussionThe increase of approximated cerebral metabolic rate of oxygen could indicate an elevated oxidative energy metabolism in the “stressed” brain, due to repair processes. The increased cerebral fractional tissue oxygen extraction fits with the decreased NIRS cerebral oxygenation. Our data suggest that an increase in cerebral oxygen metabolism was the cause.ConclusionCerebral oxygen desaturation during major surgery in neonates and infants is associated with early postoperative increased cerebral oxygen extraction and possibly increased cerebral oxygen metabolism.

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Section: Methodsmentioning

confidence: 99%

Section: Materials S and Me Thodsmentioning

confidence: 99%

The effect of intraoperative cerebral oxygen desaturations on postoperative cerebral oxygen metabolism in neonates and infants a pilot study

Jock,

Neunhoeffer,

Rörden

et al. 2023

Pediatric Anesthesia

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“…3 The near-infrared spectroscopy method of assessment of cerebral oxygen metabolism promises new insights into perioperative cerebral perfusion in infants with CHDs. 21,22 Previous studies have reported that regional cerebral oxygen saturation is mostly influenced by cerebral venous oxygen saturation in which cerebral arterial to venous volume ratio (A:V ratio) is 1:3 (25%:75%) in humans under normal physiological conditions. 19,23 Lee et al 24 reported an increase in the arterial volume fraction from 25 to 40% in response to hypercapnia.…”

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Effects of relative low minute ventilation on cerebral haemodynamics in infants undergoing ventricular septal defect repair

et al. 2020

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AbstractBackground:Ventilation-associated changes in blood carbon dioxide levels are associated with various physiological changes in infants undergoing surgery. Studies on the effects of mechanical ventilation on cerebral haemodynamics especially for infants with CHD are scarce.Aim:This study was done to compare the changes in regional cerebral oxygen saturation and cerebral blood flow velocity when the end-tidal carbon dioxide partial pressure changed during different minute ventilation settings in infants undergoing ventricular septal defect repair.Methods:A total of 67 patients less than 1 year old with ventricular septal defect were enrolled, and 65 patients (age: 6.7 ± 3.4 months, weight: 6.4 ± 1.5 kg) were studied. After anaesthesia induction and endotracheal intubation, the same mechanical ventilation mode (The fraction of inspired oxygen was 50%, and the inspiratory-to-expiratory ratio was 1:1.5.) was adopted. The end-tidal carbon dioxide partial pressure of 30 mmHg (T1), 35 mmHg (T2), 40 mmHg (T3), or 45 mmHg (T4) were obtained, respectively, by adjusting tidal volume and respiratory rate. Minute ventilation per kilogram was calculated by the formula: minute ventilation per kilogram = tidal volume * respiratory rate/kg. Regional cerebral oxygen saturation was monitored by real-time near-infrared spectroscopy. Cerebral blood flow velocity (systolic flow velocity, end-diastolic flow velocity, and mean flow velocity), pulsatility index, and resistance index were measured intermittently by transcranial Doppler. Systolic pressure, diastolic pressure, stroke volume index, and cardiac index were recorded using the pressure recording analytical method.Results:As the end-tidal carbon dioxide partial pressure increased from 30 to 45 mmHg, regional cerebral oxygen saturation increased significantly from 69 ± 5% to 79 ± 4% (p < 0.001). Cerebral blood flow velocity (systolic flow velocity, end-diastolic flow velocity, and mean flow velocity) increased linearly, while pulsatility index and resistance index decreased linearly from T1 (systolic flow velocity, 84 ± 19 cm/second; end-diastolic flow velocity, 14 ± 4 cm/second; mean flow velocity, 36 ± 10 cm/second; pulsatility index, 2.13 ± 0.59; resistance index, 0.84 ± 0.12) to T4 (systolic flow velocity, 113 ± 22 cm/second; end-diastolic flow velocity, 31 ± 6 cm/second; mean flow velocity, 58 ± 11 cm/second; pulsatility index, 1.44 ± 0.34; resistance index, 0.72 ± 0.07) (p < 0.001). There were significant differences in changes of systolic flow velocity, end-diastolic flow velocity, mean flow velocity, pulsatility index, and resistance index as the end-tidal carbon dioxide partial pressure increased from 30 to 45 mmHg between subgroups of infants ≤6 and infants >6 months, while the changes of regional cerebral oxygen saturation between subgroups were not statistically different. Regional cerebral oxygen saturation and cerebral blood flow velocity (systolic flow velocity, end-diastolic flow velocity, and mean flow velocity) were negatively correlated with minute ventilation per kilogram (r = −0.538, r = −0.379, r = −0.504, r = −0.505, p < 0.001). Pulsatility index and resistance index were positively related to minute ventilation per kilogram (r = 0.464, r = 0.439, p < 0.001). The diastolic pressure was significantly reduced from T1 (41 ± 7 mmHg) to T4 (37 ± 6 mmHg) (p < 0.001). There were no significant differences in systolic pressure, stroke volume index, and cardiac index with the change of end-tidal carbon dioxide partial pressure from T1 to T4 (p = 0.063, p = 0.382, p = 0.165, p > 0.05).Conclusion:A relative low minute ventilation strategy increases regional cerebral oxygen saturation and cerebral blood flow, which may improve cerebral oxygenation and brain perfusion in infants undergoing ventricular septal defect repair.

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Perioperative Cerebral Oxygenation Metabolism in Neonates with Hypoplastic Left Heart Syndrome or Transposition of the Great Arteries

Neunhoeffer

Hofbeck

Schlensak³

et al. 2018

Pediatr Cardiol

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Optimizing oxygen delivery to the brain is one of the main goals in children with congenital heart defects after surgery. It has been shown that cerebral oxygen saturation (cSO2) is depressed within the first day after neonatal cardiopulmonary bypass surgery. However, peri-operative cerebral oxygen metabolism has not yet been assessed in previous studies. The aim of this study was to describe the peri-operative changes in cerebral oxygen metabolism in neonates with congenital heart defects following cardiopulmonary bypass surgery. Prospective observational cohort study. PICU of a tertiary referral center. Fourteen neonates with hypoplastic left heart syndrome (HLHS) undergoing Norwood procedure and 14 neonates with transposition of great arteries (TGA) undergoing arterial switch operation (ASO) were enrolled. Pediatric heart surgery. We measured non-invasively regional cSO2 and microperfusion (rcFlow) using tissue spectrometry and laser Doppler flowmetry before and after surgery. Cerebral fractional tissue oxygen extraction (cFTOE), the arterio-cerebral difference in oxygen content (acDO2) and approximated cerebral metabolic rate of oxygen (aCMRO2) were calculated. According to the postsurgical hemodynamics, arterial saturation (aSO2) normalized immediately after surgery in the TGA group, whereas HLHS patients still were cyanotic. cSO2 significantly increased in TGA group over 48 h after ASO (p = 0.004) and was significantly higher compared to HLHS group after Norwood procedure. cFTOE as a risk marker for brain injury was elevated before surgery (TGA group 0.37 ± 0.10, HLHS group 0.42 ± 0.12) and showed a slight decrease after ASO (p = 0.35) but significantly decreased in patients after Norwood procedure (p = 0.02). Preo-peratively, acDO2 was significantly higher in patients with HLHS compared to patients with TGA (7.7 ± 2.5 vs. 5.2 ± 1.6 ml/dl, p = 0.005), but normalized in the posto-perative course. Before surgery, the aCMRO2 was slightly higher in the HLHS group (5.1 ± 1.5 vs. 3.9 ± 2.5 AU, p = 0.14), but significantly decreased after Norwood procedure (- 1.6 AU, p = 0.009). There was no difference in rcFlow between both groups and between the points in time prior and after surgery. Neonates undergoing cardiac surgery suffer from peri-operative changes in hemodynamics and cerebral hypoxemic stress. The cerebral oxygen metabolism seems to be more affected in cyanotic children with functionally univentricular hearts compared to post-operative acyanotic patients. Additional stress factors must be avoided to achieve the best possible neurological outcome.

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Non-invasive assessment of cerebral oxygen metabolism following surgery of congenital heart disease

Cited by 6 publications

References 30 publications

The effect of intraoperative cerebral oxygen desaturations on postoperative cerebral oxygen metabolism in neonates and infants a pilot study

The effect of intraoperative cerebral oxygen desaturations on postoperative cerebral oxygen metabolism in neonates and infants a pilot study

Effects of relative low minute ventilation on cerebral haemodynamics in infants undergoing ventricular septal defect repair

Perioperative Cerebral Oxygenation Metabolism in Neonates with Hypoplastic Left Heart Syndrome or Transposition of the Great Arteries

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