Combining regional oxygen saturation and lactate to predict early postoperative outcome in children undergoing congenital cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUANG Jihong , XU Zhuoming , ZHANG Mingjie ,  CAI Jiming

Cardiac Intensive Care Unit, Department of Pediatric Cardiovascular and Thoracic Surgery, Shanghai Children’s Medical Center, Medical School of Shanghai Jiaotong University, Shanghai, 200127, P.R.China;

Corresponding author：

CAI Jiming, Email: rosemarycjm@163.com

Keywords：

Congenital heart surgery; regional oxygen saturation; lactate

DOI：

10.7507/1007-4848.201903046

Video：

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Objective To assess the predictive abilities of postoperative regional oxygen saturation (rSO₂) measured by near-infrared spectroscopy (NIRS) and lactate level for early postoperative outcome in children undergoing congenital heart disease surgery.Methods A total of 73 children (43 males, 30 females, mean age of 91±18 days) undergoing cardiovascular surgery were enrolled from December 2016 to September 2017. The 73 children were divided into an early poor outcome group and a without poor outcome group. Binary logistic regression method was used to determine the independent factors of predicting early poor outcome. Receiver operating characteristic curve was used to identify the optimal cutoff values.Results The early poor outcome rate was 47%. By regression analyses, nadir splanchnic rSO₂ values, peak lactate level were 2 independent factors of predicting poor outcome. For nadir splanchnic rSO₂ alone, the area under the ROC curve for poor outcome were 0.897. For peak lactate alone, the area under the ROC curve for poor outcome was 0.867. After combination of nadir splanchnic rSO₂ and peak lactate, the area under the ROC curve for poor outcome increased to 0.944 (P<0.05).Conclusion Combining the parameter of nadir splanchnic rSO₂ and peak lactate during the first postoperatively 24 hours yielded to a more accurate predictive ability for early outcome in children undergoing congenital cardiac surgery.

Citation： HUANG Jihong, XU Zhuoming, ZHANG Mingjie, CAI Jiming. Combining regional oxygen saturation and lactate to predict early postoperative outcome in children undergoing congenital cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(8): 772-776. doi: 10.7507/1007-4848.201903046 Copy

1.	Eytan D, Goodwin A, Laussen P, et al. Insights from multi-dimensional physiological signals to predict and prevent cardiac arrests. Pediatr Crit Care Med, 2016, 17(1): 81-82.
2.	Axelrod DM, Klugman D, Wright GE, et al. Board members of the pediatric cardiac intensive care society. one hundred useful references in pediatric cardiac intensive care: the 2012 update. Pediatr Crit Care Med, 2013, 14(8): 770-785.
3.	Goyal N, Taylor AR, Rivers EP, et al. Relationship between central and peripheral venous oxygen saturation and lactate levels: A prospective study. J Emerg Med, 2016, 50(6): 809-817.
4.	Shin TG, Jo IJ, Hwang SY, et al. Comprehensive interpretation of central venous oxygen saturation and blood lactate levels during resuscitation of patients with severe sepsis and septic shock in the emergency department. Shock, 2016, 45(1): 4-9.
5.	Ghanayem NS, Hoffman GM. Near infrared spectroscopy as a hemodynamic monitor in critical illness. Pediatr Crit Care Med, 2016, 17(8 Suppl 1): S201-206.
6.	Aly SA, Zurakowski D, Glass P, et al. Cerebral tissue oxygenation index and lactate at 24 hours postoperative predict survival and neurodevelopmental outcome after neonatal cardiac surgery. Congenit Heart Dis, 2017, 12(2): 188-195.
7.	Suemori T, Skowno J, Horton S, et al. Cerebral oxygen saturation and tissue hemoglobin concentration as predictive markers of early postoperative outcomes after pediatric cardiac surgery. Paediatr Anaesth, 2016, 26(2): 182-189.
8.	Rocha LA, Froio SC, Silva CC, et al. Risk factors for mortality in children with congenital heart disease delivered at a Brazilian tertiary center. Braz J Cardiovasc Surg, 2018, 33(6): 603-607.
9.	Moreno GE, Pilán ML, Manara C, et al. Regional venous oxygen saturation versus mixed venous saturation after paediatric cardiac surgery. Acta Anaesthesiol Scand, 2013, 57(3): 373-379.
10.	DeWitt AG, Charpie JR, Donohue JE, et al. Splanchnic near-infrared spectroscopy and risk of necrotizing enterocolitis after neonatal heart surgery. Pediatr Cardiol, 2014, 35(7): 1286-1294.
11.	Andersen LW, Holmberg MJ, Doherty M, et al. Postoperative lactate levels and hospital length of stay after cardiac surgery. J Cardiothorac Vasc Anesth, 2015, 29(6): 1454-1460.
12.	Hickok RL, Spaeder MC, Berger JT, et al. Postoperative abdominal NIRS values predict low cardiac output syndrome in neonates. World J Pediatr Congenit Heart Surg, 2016, 7(2): 180-184.
13.	Scott JP, Hoffman GM. Near-infrared spectroscopy: exposing the dark (venous) side of the circulation. Paediatr Anaesth, 2014, 24(1): 74-88.
14.	Blaber AP, Hinghofer-Szalkay H, Goswami N. Blood volume redistribution during hypovolemia. Aviat Space Environ Med, 2013, 84(1): 59-64.
15.	Wu CY, Chan KC, Cheng YJ, et al. NTUH Center of Microcirculation Medical Research. Effects of different types of fluid resuscitation for hemorrhagic shock on splanchnic organ microcirculation and renal reactive oxygen species formation. Crit Care, 2015, 11(19): 434.
16.	Fudim M, Hernandez AF, Felker GM. Role of volume redistribution in the congestion of heart failure. J Am Heart Assoc, 2017, 6(8): e006817.
17.	Hoffman GM, Ghanayem NS, Scott JP, et al. Postoperative cerebral and somatic near-infrared spectroscopy saturations and outcome in hypoplastic left heart syndrome. Ann Thorac Surg, 2017, 103(5): 1527-1535.
18.	Kim JW, Shin WJ, Park I, et al. Splanchnic oxygen saturation immediately after weaning from cardiopulmonary bypass can predict early postoperative outcomes in children undergoing congenital heart surgery. Pediatr Cardiol, 2014, 35(4): 587-595.
19.	Minton J, Sidebotham DA. Hyperlactatemia and cardiac surgery. J Extra Corpor Technol, 2017, 49(1): 7-15.
20.	Schumacher KR, Reichel RA, Vlasic JR, et al. Rate of increase in serum lactate level risk-stratifies infants after surgery for congenital heart disease. J Thorac Cardiovasc Surg, 2014, 148(2): 589-595.
21.	Hofmann B, Gmelin MJ, Metz D, et al. Cardiac surgery score (CASUS) improves outcome prediction in patients treated with extracorporal life support (ECLS). Perfusion, 2018, 33(1): 36-43.
22.	Palermo RA, Palac HL, Wald EL, et al. Metabolic uncoupling following cardiopulmonary bypass. Congenit Heart Dis, 2015, 10(6): E250-257.
23.	Vida VL, Tessari C, Cristante A, et al. The role of regional oxygen saturation using near-infrared spectroscopy and blood lactate levels as early predictors of outcome after pediatric cardiac surgery. Can J Cardiol, 2016, 32(8): 970-977.

1. Eytan D, Goodwin A, Laussen P, et al. Insights from multi-dimensional physiological signals to predict and prevent cardiac arrests. Pediatr Crit Care Med, 2016, 17(1): 81-82.
2. Axelrod DM, Klugman D, Wright GE, et al. Board members of the pediatric cardiac intensive care society. one hundred useful references in pediatric cardiac intensive care: the 2012 update. Pediatr Crit Care Med, 2013, 14(8): 770-785.
3. Goyal N, Taylor AR, Rivers EP, et al. Relationship between central and peripheral venous oxygen saturation and lactate levels: A prospective study. J Emerg Med, 2016, 50(6): 809-817.
4. Shin TG, Jo IJ, Hwang SY, et al. Comprehensive interpretation of central venous oxygen saturation and blood lactate levels during resuscitation of patients with severe sepsis and septic shock in the emergency department. Shock, 2016, 45(1): 4-9.
5. Ghanayem NS, Hoffman GM. Near infrared spectroscopy as a hemodynamic monitor in critical illness. Pediatr Crit Care Med, 2016, 17(8 Suppl 1): S201-206.
6. Aly SA, Zurakowski D, Glass P, et al. Cerebral tissue oxygenation index and lactate at 24 hours postoperative predict survival and neurodevelopmental outcome after neonatal cardiac surgery. Congenit Heart Dis, 2017, 12(2): 188-195.
7. Suemori T, Skowno J, Horton S, et al. Cerebral oxygen saturation and tissue hemoglobin concentration as predictive markers of early postoperative outcomes after pediatric cardiac surgery. Paediatr Anaesth, 2016, 26(2): 182-189.
8. Rocha LA, Froio SC, Silva CC, et al. Risk factors for mortality in children with congenital heart disease delivered at a Brazilian tertiary center. Braz J Cardiovasc Surg, 2018, 33(6): 603-607.
9. Moreno GE, Pilán ML, Manara C, et al. Regional venous oxygen saturation versus mixed venous saturation after paediatric cardiac surgery. Acta Anaesthesiol Scand, 2013, 57(3): 373-379.
10. DeWitt AG, Charpie JR, Donohue JE, et al. Splanchnic near-infrared spectroscopy and risk of necrotizing enterocolitis after neonatal heart surgery. Pediatr Cardiol, 2014, 35(7): 1286-1294.
11. Andersen LW, Holmberg MJ, Doherty M, et al. Postoperative lactate levels and hospital length of stay after cardiac surgery. J Cardiothorac Vasc Anesth, 2015, 29(6): 1454-1460.
12. Hickok RL, Spaeder MC, Berger JT, et al. Postoperative abdominal NIRS values predict low cardiac output syndrome in neonates. World J Pediatr Congenit Heart Surg, 2016, 7(2): 180-184.
13. Scott JP, Hoffman GM. Near-infrared spectroscopy: exposing the dark (venous) side of the circulation. Paediatr Anaesth, 2014, 24(1): 74-88.
14. Blaber AP, Hinghofer-Szalkay H, Goswami N. Blood volume redistribution during hypovolemia. Aviat Space Environ Med, 2013, 84(1): 59-64.
15. Wu CY, Chan KC, Cheng YJ, et al. NTUH Center of Microcirculation Medical Research. Effects of different types of fluid resuscitation for hemorrhagic shock on splanchnic organ microcirculation and renal reactive oxygen species formation. Crit Care, 2015, 11(19): 434.
16. Fudim M, Hernandez AF, Felker GM. Role of volume redistribution in the congestion of heart failure. J Am Heart Assoc, 2017, 6(8): e006817.
17. Hoffman GM, Ghanayem NS, Scott JP, et al. Postoperative cerebral and somatic near-infrared spectroscopy saturations and outcome in hypoplastic left heart syndrome. Ann Thorac Surg, 2017, 103(5): 1527-1535.
18. Kim JW, Shin WJ, Park I, et al. Splanchnic oxygen saturation immediately after weaning from cardiopulmonary bypass can predict early postoperative outcomes in children undergoing congenital heart surgery. Pediatr Cardiol, 2014, 35(4): 587-595.
19. Minton J, Sidebotham DA. Hyperlactatemia and cardiac surgery. J Extra Corpor Technol, 2017, 49(1): 7-15.
20. Schumacher KR, Reichel RA, Vlasic JR, et al. Rate of increase in serum lactate level risk-stratifies infants after surgery for congenital heart disease. J Thorac Cardiovasc Surg, 2014, 148(2): 589-595.
21. Hofmann B, Gmelin MJ, Metz D, et al. Cardiac surgery score (CASUS) improves outcome prediction in patients treated with extracorporal life support (ECLS). Perfusion, 2018, 33(1): 36-43.
22. Palermo RA, Palac HL, Wald EL, et al. Metabolic uncoupling following cardiopulmonary bypass. Congenit Heart Dis, 2015, 10(6): E250-257.
23. Vida VL, Tessari C, Cristante A, et al. The role of regional oxygen saturation using near-infrared spectroscopy and blood lactate levels as early predictors of outcome after pediatric cardiac surgery. Can J Cardiol, 2016, 32(8): 970-977.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Combining regional oxygen saturation and lactate to predict early postoperative outcome in children undergoing congenital cardiac surgery

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