title: A retrospective study about cerebral near-infrared spectroscopy monitoring during paediatric cardiac surgery and intra-operative patient blood management.
abstract: OBJECTIVE
  Cerebral non-invasive monitoring of oxygen saturation by near-infrared spectroscopy (rSO2) during paediatric cardiac surgery is supposed to decrease the risk of neurological complications. Since haemoglobin level is one of the factors changing rSO2, we aimed to explore if rSO2 monitoring influences intra-operative RBC (red blood cell) transfusion threshold and volumes, as well as the duration of ICU stay.
  
  
  METHODS
  The design was a retrospective analysis involving 91 children less than 2 years of age (including 16 neonates) with a congenital heart disease requiring surgical treatment with or without cardiopulmonary bypass from January 2006 to August 2009. Systematic rSO2 monitoring was introduced after September 2007 (n=56). The independent factors associated with the intra-operative transfusion threshold haemoglobin (Hb) level>9.5g/dL, total volume of intra-operative RBC transfusion<30mL/kg and ICU stay<6 days were identified by multivariate analysis logistic regression. Data were expressed as medians (25-75%).
  
  
  RESULTS
  Cardiac malformations and demographic characteristics were similar in both periods. Two independent factors, weight and rSO2 monitoring, were identified as independent factors associated with the three end-points. The transfusion threshold, total transfusion volume and ICU stay with and without rSO2 were 9.8 (8.9 to 10.3) versus 8.7 (8.2 to 9.6) g/dL (P<0.0001), 20 (14-49) versus 36 (22.5-51.5) mL/kg (P=0.0165) and 5 (3-8) versus 7 (5-10.7) days (P=0.0084), respectively.
  
  
  CONCLUSIONS
  rSO2 monitoring changed our transfusion strategy with an earlier transfusion but a reduced total RBC volume and decreased the length of ICU stay.
authors.affiliation: Service d'anesthésie et de réanimation chirurgicale, Hôtel Dieu-RCH, hôpital Mère-Enfant, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France. Electronic address: corinne.lejus@chu-nantes.fr.
authors.forename: Corinne
authors.initials: C
authors.lastname: Lejus
authors.affiliation: Service d'anesthésie et de réanimation chirurgicale, Hôtel Dieu-RCH, hôpital Mère-Enfant, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France.
authors.forename: Ariane
authors.initials: A
authors.lastname: De Windt
authors.affiliation: Service d'anesthésie et de réanimation chirurgicale, Hôtel Dieu-RCH, hôpital Mère-Enfant, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: LeBoeuf-Pouliquen
authors.affiliation: Service d'anesthésie et de réanimation chirurgicale, Hôtel Dieu-RCH, hôpital Mère-Enfant, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Le Roux
authors.affiliation: Service d'anesthésie et de réanimation chirurgicale, Hôtel Dieu-RCH, hôpital Mère-Enfant, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Bérard
authors.affiliation: Service d'anesthésie et de réanimation chirurgicale, Hôtel Dieu-RCH, hôpital Mère-Enfant, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 01, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Asehnoune
mesh_terms: D001803:Blood Transfusion / Q000379:methods*; D001810:Blood Volume; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D003422:Critical Care; D023381:Endpoint Determination; D017707:Erythrocyte Transfusion; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007430:Intraoperative Care / Q000379:methods*; D007902:Length of Stay; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D010100:Oxygen / Q000097:blood; D012189:Retrospective Studies; D019265:Spectroscopy, Near-Infrared
chemical_list: D006454:Hemoglobins; D010100:Oxygen
keywords: Blood transfusion; Cardiac surgery; Cerebral near-infrared spectroscopy; Paediatric surgery