title: Cerebral oxygen saturation and tissue hemoglobin concentration as predictive markers of early postoperative outcomes after pediatric cardiac surgery.
abstract: BACKGROUND
  Near-infrared spectroscopy (NIRS) provides an assessment of cerebral oxygenation and tissue hemoglobin concentration.
  
  
  OBJECTIVE
  The aim of this study was to investigate whether the cerebral oxygenation and hemoglobin concentration measured with NIRS could predict outcomes after pediatric cardiac surgery.
  
  
  METHODS
  We conducted a retrospective observational study in 399 patients who underwent pediatric cardiac surgery. Associations were determined between postoperative outcome and preoperative and postoperative cerebral tissue oxygenation index (TOI), postoperative normalized tissue hemoglobin index (nTHI), concentration changes in oxygenated hemoglobin (Δ[HbO2 ]) and deoxygenated hemoglobin (Δ[HHb]).
  
  
  RESULTS
  Thirty-nine children had major postoperative morbidity and 12 died. Using Spearman's correlation analysis, postoperative lower TOI and higher Δ[HHb] were associated with longer stays in the Intensive Care Unit (ICU) (r = -0.48, P < 0.001, r = 0.31, P < 0.001, respectively) and longer duration of intubation (r = -0.48, P < 0.001, r = 0.31, P < 0.001, respectively) and higher probability of death determined by the Risk Adjusted Classification for Congenital Heart Surgery (RACHS-1) (r = -0.39, P < 0.001, r = 0.23, P < 0.001, respectively). In multivariate regression analysis, postoperative TOI was independently associated with major morbidity and mortality and Δ[HHb] was independently associated with major morbidity. In receiver operating characteristic analysis, postoperative TOI and Δ[HHb] predicted major morbidity (Area under the curve [AUC] = 0.72, 0.68, respectively) and mortality (AUC = 0.81, 0.69, respectively).
  
  
  CONCLUSIONS
  Lower TOI or higher [HHb] at the end of surgery and higher RACHS-1 category predicted worse outcomes.
authors.affiliation: Anaesthesia and Pain Management Research Group, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.|Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Suemori
authors.affiliation: Department of Anaesthesia, The Children's Hospital at Westmead, Westmead, NSW, Australia.|Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: Skowno
authors.affiliation: Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Vic., Australia.|Heart Research, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.
authors.forename: Steve
authors.initials: S
authors.lastname: Horton
authors.affiliation: Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Vic., Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bottrell
authors.affiliation: Intensive Care Unit, The Royal Children's Hospital, Melbourne, Vic., Australia.|Paediatric Intensive Care, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.
authors.forename: Warwick
authors.initials: W
authors.lastname: Butt
authors.affiliation: Anaesthesia and Pain Management Research Group, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.|Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Vic., Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Davidson
mesh_terms: D019540:Area Under Curve; D001921:Brain / Q000378:metabolism*; D006348:Cardiac Surgical Procedures; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002675:Child, Preschool; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007223:Infant; D008297:Male; D010100:Oxygen / Q000378:metabolism*; D011183:Postoperative Complications / Q000378:metabolism*; D011184:Postoperative Period; D012372:ROC Curve; D012189:Retrospective Studies; D019265:Spectroscopy, Near-Infrared
chemical_list: D006454:Hemoglobins; D010100:Oxygen
keywords: cerebral ischemia; congenital heart defects; deoxyhemoglobin; near-infrared spectroscopy; oxyhemoglobin; prognosis