A Cross-Sectional Survey of Near-Infrared Spectroscopy Use in Pediatric Cardiac ICUs in the United Kingdom, Ireland, Italy, and Germany.
OBJECTIVE
Despite the increasing use of near-infrared spectroscopy across pediatric cardiac ICUs, there is significant variability and equipoise with no universally accepted management algorithms. We aimed to explore the use of near-infrared spectroscopy in pediatric cardiac ICUs in the United Kingdom, Ireland, Italy, and Germany.


METHODS
A cross-sectional multicenter, multinational electronic survey of one consultant in each pediatric cardiac ICU.


METHODS
Pediatric cardiac ICUs in the United Kingdom and Ireland (n = 13), Italy (n = 12), and Germany (n = 33).


METHODS
Questionnaire targeted to establish use, targets, protocols/thresholds for intervention, and perceived usefulness of near-infrared spectroscopy monitoring.


RESULTS
Overall, 42 of 58 pediatric cardiac ICUs (72%) responded: United Kingdom and Ireland, 11 of 13 (84.6%); Italy, 12 of 12 (100%); and Germany, 19 of 33 (57%, included all major centers). Near-infrared spectroscopy usage varied with 35% (15/42) reporting that near-infrared spectroscopy was not used at all (7/42) or occasionally (8/42); near-infrared spectroscopy use was much less common in the United Kingdom (46%) when compared with 78% in Germany and all (100%) in Italy. Only four units had a near-infrared spectroscopy protocol, and 18 specifically used near-infrared spectroscopy in high-risk patients; 37 respondents believed that near-infrared spectroscopy added value to standard monitoring and 23 believed that it gave an earlier indication of deterioration, but only 19 would respond based on near-infrared spectroscopy data alone. Targets for absolute values and critical thresholds for intervention varied widely between units. The reasons cited for not or occasionally using near-infrared spectroscopy were expense (n = 6), limited evidence and uncertainty on how it guides management (n = 4), difficulty in interpretation, and unreliability of data (n = 3). Amongst the regular or occasional near-infrared spectroscopy users (n = 35), 28 (66%) agreed that a multicenter study is warranted to ascertain its use.


CONCLUSIONS
Although most responding units used near-infrared spectroscopy for high-risk patients, the majority (31/35 [88%]) did not have any protocols or guidelines for intervention. Target thresholds and intervention algorithms are needed to support the use of near-infrared spectroscopy in pediatric cardiac ICUs; an international multicenter study is warranted.
1Cardiac Intensive Care Unit, Critical Care and Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom. 2Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, United Kingdom. 3Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany. 4Department of Pediatric Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany. 5Anaesthesia and Pediatric Cardiac Intensive Care, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children Hospital, Rome, Italy.
Aparna U
AU
Hoskote
Lyvonne N
LN
Tume
Uwe
U
Trieschmann
Christoph
C
Menzel
Paola
P
Cogo
Katherine L
KL
Brown
Michael W
MW
Broadhead
D000465:Algorithms; D001921:Brain / Q000098:blood supply; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D005060:Europe; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D019990:Perioperative Care / Q000379:methods*; D018570:Risk Assessment; D019265:Spectroscopy, Near-Infrared / Q000706:statistics & numerical data*
D010100:Oxygen