title: Prolonged central venous desaturation measured by continuous oximetry is associated with adverse outcomes in pediatric cardiac surgery.
abstract: BACKGROUND
  The role of continuous central venous oxygen saturation (ScvO₂) oximetry during pediatric cardiac surgery for predicting adverse outcomes is not known. Using a recently available continuous ScvO₂ oximetry catheter, we examined the association between venous oxygen desaturations and patient outcomes. We hypothesized that central venous oxygen desaturations are associated with adverse clinical outcomes.
  
  
  METHODS
  Fifty-four pediatric patients undergoing cardiac surgery were prospectively enrolled in an unblinded observational study. ScvO₂ was measured continuously in the operating room and for up to 24 h post-Intensive Care Unit admission. The relationships between ScvO₂ desaturations, clinical outcomes, and major adverse events were determined.
  
  
  RESULTS
  More than 18 min of venous saturations less than 40% were associated with major adverse events with 100% sensitivity and 97.6% specificity. Significant correlations resulted between the ScvO₂ area under the curve less than 40% and creatinine clearance at 12 h in the Intensive Care Unit (r = -0.58), Intensive Care Unit length of stay (r = 0.56), max inotrope use (r = 0.52), inotrope use at 24 h (r = 0.40), inotrope index score (r = 0.39), hospital length of stay (r = 0.36), and length of intubation (r = 0.32).
  
  
  CONCLUSIONS
  We demonstrate that ScvO₂ desaturations by continuous oximetry are associated with major adverse events in pediatric patients undergoing cardiac surgery. The most significant associations with major adverse events are seen in patients with greater than 18 min of central venous saturations less than 40%. Our results support the further investigation of ScvO₂ as a potential target parameter in high-risk pediatric patients to minimize the risk of major adverse events.
authors.affiliation: Department of Anesthesiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Crowley
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sanchez
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Ho
authors.forename: Kate J
authors.initials: KJ
authors.lastname: Lee
authors.forename: Johanna
authors.initials: J
authors.lastname: Schwarzenberger
authors.forename: Jure
authors.initials: J
authors.lastname: Marijic
authors.forename: Michael
authors.initials: M
authors.lastname: Sopher
authors.forename: Aman
authors.initials: A
authors.lastname: Mahajan
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies; D012044:Regression Analysis
chemical_list: D010100:Oxygen