title: The Correlation of Two Cerebral Saturation Monitors With Jugular Bulb Oxygen Saturation in Children Undergoing Cardiopulmonary Bypass for Congenital Heart Surgery.
abstract: BACKGROUND
  Near-infrared spectroscopy (NIRS) is a noninvasive monitoring technique that measures regional cerebral oxygen saturation (rSO2).
  
  
  OBJECTIVE
  The primary aim was to compare the output of 2 NIRS-based cerebral oximetry devices, FORESIGHT (CAS Medical Systems Inc, Branford, Connecticut) and INVOS (Covidien, Boulder, Colorado), to venous oxygen saturations from the jugular venous bulb at cannulation and decannulation of the superior vena cava (SVC). Secondary objectives included evaluating correlations of cerebral saturation, as measured by the NIRS devices, with mean arterial blood pressure (MAP), measured by an invasive arterial line, and end-tidal CO2(ETCO2).
  
  
  METHODS
  Near-infrared spectroscopy, MAP, and ETCO2data were collected at 13 defined events during each case when hemodynamic instability was expected. At SVC cannulation and decannulation, a 0.1 mL sample of blood was collected from the jugular bulb by the surgeon using a long angiocatheter. The oxygen saturation of these blood samples was measured using an AVOX device and compared with contemporaneous readings from the NIRS probes. Mixed-effects linear regression was used to correlate MAP or ETCO2with cerebral oxygen saturation (by NIRS) at each time point.
  
  
  RESULTS
  Children undergoing cardiopulmonary bypass for congenital heart surgery (n = 34) were enrolled in the study. At SVC cannulation, both INVOS ( r = .78) and FORESIGHT ( r = .59) were correlated with AVOX data at P < .001, although the correlation with INVOS was significantly stronger ( P = .003). At SVC decannulation, INVOS ( r = .68; P < .001) and FORESIGHT ( r = .60; P < .001) were similarly correlated with jugular venous rSO2. Correlations of rSO2(by NIRS) with MAP and ETCO2levels were stronger than correlations between rSO2change and change in MAP or ETCO2.
  
  
  CONCLUSIONS
  INVOS correlated more strongly than FORESIGHT with the jugular bulb rSO2at SVC cannulation but may have underestimated oxygen saturation at low rSO2values. Data from both NIRS devices were correlated with MAP and ETCO2over the case duration.
authors.affiliation: 1 Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|2 Department of Anesthesia, The Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Aymen N
authors.initials: AN
authors.lastname: Naguib
authors.affiliation: 1 Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|2 Department of Anesthesia, The Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Winch
authors.affiliation: 1 Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|2 Department of Anesthesia, The Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Roby
authors.initials: R
authors.lastname: Sebastian
authors.affiliation: 2 Department of Anesthesia, The Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gomez
authors.affiliation: 3 Department of Microbiology, College of Arts and Sciences, The Ohio State University, Columbus, OH, USA.
authors.forename: Luisa
authors.initials: L
authors.lastname: Guzman
authors.affiliation: 1 Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Rice
authors.affiliation: 1 Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Tumin
authors.affiliation: 2 Department of Anesthesia, The Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Galantowicz
authors.affiliation: 1 Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|2 Department of Anesthesia, The Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D002315:Cardiopulmonary Bypass / Q000295:instrumentation* / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007601:Jugular Veins; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D010092:Oximetry / Q000295:instrumentation* / Q000379:methods; D019265:Spectroscopy, Near-Infrared / Q000295:instrumentation* / Q000379:methods
keywords: anesthesia; brain tissue oxygen tension; clinical research; hemodynamic monitoring; monitoring