The prognostic value of cerebral oxygen saturation, lactate and mixed venous oxygen levels in predicting the major adverse events during pediatric cardiac surgery

Abstract

Objective: Major adverse events (MAE) that may occur after pediatric cardiac surgery increase the risk for mortality and morbidity. In this context, the objective of this study is to assess the prognostic value of perioperative cerebral oxygen saturation levels measured by near-infrared spectroscopy (NIRS-ScO2) and lactate and mixed venous blood oxygen saturation (MVO) levels in predicting the development of MAE after the surgery. Material and Methods:The study population consisted of the patients who underwent pediatric cardiac surgery and were followed up in the pediatric cardiac intensive care unit between February 1, 2022, and June 1, 2022. MAEs include sudden cardiac arrest/death, unscheduled emergency re-operation, and low cardiac output syndrome. The roles of NIRS-ScO2, lactate, and MVO levels during the surgery in predicting MAE were investigated. The results were evaluated statistically. Results:The study sample consisted of 130 patients, of whom 50% were male. The median age of the study sample was 4 (interquartile range: 1-7) months. MAE was detected in 16.9% of the cases. More than 30% change in theNIRS-ScO2 levels in the operative period (area under the curve [AUC]: 0.84, sensitivity 65%, specificity 85%, and positive predictive value [PPV]: 90%) and a MVO/lactate ratio<5 (AUC: 0.72, sensitivity 76%, specificity 82%, and PPV 88%) were determined to be strongly predictive of MAE. Conclusion: More than 30% change in the perioperativeNIRS-ScO2 levels and an MVO/lactate ratio <5 can be used to predict the development of MAEs.