title: Splanchnic oxygen saturation immediately after weaning from cardiopulmonary bypass can predict early postoperative outcomes in children undergoing congenital heart surgery.
abstract: This study compared the abilities of cerebral, renal, and splanchnic regional oxygen saturation (rSO2) immediately after weaning from cardiopulmonary bypass (CPB) to predict early postoperative outcomes for children undergoing congenital heart surgery. The study enrolled 73 children (ages 0.1-72 months) undergoing corrective or palliative cardiac surgery requiring CPB. Laboratory and hemodynamic variables were analyzed at the time of successful weaning from CPB. Using near-infrared spectroscopy, cerebral, renal, and splanchnic rSO2 values were obtained simultaneously. Early postoperative outcome measures included the maximum vasoactive inotropic score (VIS(max)) during the first 36 postoperative hours, the duration of mechanical ventilation, and the postoperative hospital length of stay. In the univariate analysis, cerebral, renal, and splanchnic rSO2 values correlated significantly with early postoperative outcomes. However, splanchnic rSO2 was the only independent factor predicting VIS(max) (β = -0.302, P = 0.021), duration of mechanical ventilation (β = -0.390, P = 0.002), and postoperative hospital length of stay (β = -0.340, P = 0.001) by multivariate analyses. Splanchnic rSO2 had a larger receiver operating characteristic area under the curve (AUC) for determining high VIS(max), prolonged mechanical ventilation, and longer postoperative hospital stay (AUC 0.775, 0.792, and 0.776, respectively) than cerebral (AUC 0.630, 0.638, and 0.632, respectively) and renal (AUC 0.703, 0.716, and 0.715, respectively) rSO2. After weaning from CPB, splanchnic rSO2 may be superior to rSO2 measured from brain and kidney in predicting an increased requirement for vasoactive inotropic support, a prolonged mechanical ventilation, and a longer postoperative hospital stay for children.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Kim
authors.forename: Won-Jung
authors.initials: WJ
authors.lastname: Shin
authors.forename: Inkyung
authors.initials: I
authors.lastname: Park
authors.forename: In-Sun
authors.initials: IS
authors.lastname: Chung
authors.forename: Mijeung
authors.initials: M
authors.lastname: Gwak
authors.forename: Gyu-Sam
authors.initials: GS
authors.lastname: Hwang
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000639:trends; D008297:Male; D010092:Oximetry; D010101:Oxygen Consumption / Q000502:physiology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D011379:Prognosis; D012372:ROC Curve; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D013152:Splanchnic Circulation / Q000502:physiology*; D013997:Time Factors
chemical_list: D002316:Cardiotonic Agents