Tissue oxygenation monitoring during major pediatric surgery using transcutaneous liver near infrared spectroscopy.
BACKGROUND
The aim of the study was to compare liver tissue oxygenation determined by near infrared spectroscopy (NIRS) with central venous oxygen saturation (SvO(2)) and intestinal perfusion as measured by gastric intramucosal pH (pHi) in pediatric surgical patients.


METHODS
Twenty children undergoing craniofacial surgery with expected major intraoperative blood loss were studied. NIRS tissue oxygenation index (TOI(Liver)) and pHi values were recorded. Arterial blood gas analysis and SvO(2) were assessed from periodically taken blood samples. Data are presented as ranges (median) and were compared using linear regression analysis. Sensitivity and specificity of the intra-individual changes in TOI(Liver) to predict falling SvO(2) or pHi values were calculated.


RESULTS
Patients age ranged from 0.79 to 8.27 years (1.92 years). TOI(Liver) ranged from 41.5 to 77.4% (61.5%), gastric pHi from 7.13 to 7.60 (7.37) and SvO(2) from 51 to 86% (74%). Among patients only moderate correlation was found between TOI(Liver) and SvO(2) (r = 0.594, P < 0.0001) and gastric pH(i) (r = 0.502, P < 0.0001). Intra-individual measured TOI(Liver) values, however, demonstrated close correlation with SvO(2) values (r = 0.680 to 0.976) but a varying correlation with gastric pHi values (r = 0.055 to 0.972). Sensitivity/specificity of TOI(Liver) to predict decreasing SvO(2) or gastric pHi values were 76.4/73.4% and 67.4/62.7% respectively.


CONCLUSIONS
TOI(Liver) provided a better trend monitor of central venous oxygen saturation than gastric intramucosal pH. Because of its limited sensitivity and specificity to indicate deterioration of SvO(2), liver tissue oxygenation measured by transcutaneous NIRS does not provide additional practical information for clinical management.
Weiss
Markus
M
Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland. markus.weiss@kispi.unizh.ch
Schulz
Gabriele
G
Teller
Ian
I
Dullenkopf
Alexander
A
Kolarova
Anna
A
Sailer
Herrmann
H
Dillier
Claudia M
CM
Bucher
Hans U
HU
Gerber
Andreas C
AC
Baenziger
Oskar
O
D001784:Blood Gas Analysis / Q000379:methods; D002405:Catheterization, Central Venous / Q000379:methods; D002648:Child; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000601:surgery; D005260:Female; D005753:Gastric Mucosa; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D016014:Linear Models; D008099:Liver / Q000378:metabolism*; D008297:Male; D008365:Manometry; D016343:Monitoring, Intraoperative / Q000379:methods*; D010100:Oxygen / Q000097:blood / Q000378:metabolism*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D019265:Spectroscopy, Near-Infrared / Q000379:methods*
D010100:Oxygen