NEAR-INFRARED SPECTROSCOPY: APPLICATIONS IN PEDIATRIC ANESTHESIA AND BEYOND Faith J. Ross, MD Seattle Children’s Hospital, University of Washington
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
NEAR-INFRARED SPECTROSCOPY: APPLICATIONS IN PEDIATRIC ANESTHESIA AND BEYOND
Faith J. Ross, MD Seattle Children’s Hospital, University of Washington
Background How it works
Near-infrared light emitted from source penetrates skull absorbed by Hgb reaches detectors
Differences from pulse oximetry 70-75% venous sampling Does not require pulsatile flow
Frontal cortex has limited oxygen reserve so dec cerebral O2 sat may be early warning
Measures to increase cerebral O2 Increase MAP Increase FiO2 Increase PaO2 Increase Hgb
Anesthesia Patient Safety Foundation
NIRS vs. SvO2, SjO2
Nagdyman et al. 2008
rSO2/SjO2 R = 0.83
rSO2/SvO2 R = 0.93
rSO2 correlates with systemic and jugular venous saturation
NIRS and tissue injury
Kurth et al. 2009
ScO2 vs. tissue lactate
Time threshold for ScO2 < 35% for ischemic damage ~ 2hrs
Kurth et al. 2002
Abnormal neurologic outcome vs. HI time
Threshold for biochemical dysfunction ScO2 ~ 35-45%
NIRS and outcomes in cardiac surgery
Austin et al. 1997
Intervention for cerebral monitoring events associated with improved outcome
Cerebral desaturation and long term outcomes
Lower Psychomotor Development Index a/w lower rSO2 60 min after separation from bypass
Kussman et al. 2010
Somatic – Cerebral rSO2 difference
Hoffman et al. 2004, 2007
Somatic – cerebral rSO2 difference < 10 indicates somatic ischemia
Complications, Shock, Mortality vs. Somatic-Cerebral rSO2 difference in children undergoing stage 1 palliation for CHD
Cerebro-splanchnic oxygenation ratio
TOIabd/TOIbrain for controls and acute abdomen ROC Curve
CSOR < 0.75 indicates increased splanchnic oxygen extraction ~ Intestinal ischemia - Sensitivity 0.90, Specificity 0.96
Fortune et al. 2001
NIRS in acute hemorrhage
Cerebral and somatic rSO2 decrease in acute hemorrhage – Somatic rO2 more sensitive
Torello et al. 2002
NIRS in Dehydration
Hansen et al. 2009
Somatic rSO2 and Somatic-Cerebral rSO2 difference increase with rehydration
NIRS in Septic Shock
Payen et al. 2009
StO2 reperfusion slope differentiates septic vs. healthy patients
Some adult studies
Adult literature
Adult literature
Adult literature
Adult literature
Other applications
Other applications
Other applications
Other applications
References Lee JK, et al. Cerebrovascular autoregulation in pediatric moyamoya disease. Pediatric
Anesthesia. 2013; 23(6):547-56 Kasman N, Brady K. Cerebral oximetry for pediatric anesthesia: why do intelligent
clinicians disagree? Pediatric Anesthesia. 2011;21(5):473-8. Troianos CA. Cerebral Oximetry May Provide Helpful Information. Anesthesia Patient
Safety Foundation Newsletter. 2004; 24(1). (Accessed at www.aspf.org) Hoffman GM, Ghanayem NS, Stuth EA, et al: NIRS-derived somatic and cerebral
saturation difference provides non-invasive real-time hemodynamic assessment of cardiogenic shock and risk of anaerobc metabolism. Anesthesiology 2004; 102:A1448. Available at http://www.asaabstracts.com/strands/asaabstracts/abstract.htm;jsessionid=53CE5095749F75BAB1C71897D35CF578?year=2004&index=16&absnum=2206. Accessed Oct, 27 2014.
Hoffman GM, Ghanayem NS, Mussatto KA, et al. Postoperative two-site NIRS predicts complications and mortality after stage 1 palliation of HLHS. Anesthesiology 2007;107:A234. Available at http://www.asaabstracts.com/strands/asaabstracts/abstract.htm;jsessionid=26845161953B1D07D9406FC4EFE80F6F?year=2007&index=16&absnum=1585. Accessed Oct 27, 2014.
References Nagdyman N, Ewert P, Peters B, et al. Comparison of different near-infrared
spectoscopic cerebral oxygenation indices with central venous and jugular venous oxygenation saturation in children. Paediatr Anaes 2008; 18:160-166.
Kurth CD, McCann JC, Wu J, Miles L, Loepke AW. Cerebral Oxygen Saturation-Time Threshold for Hypoxic-Ischemic Injury in Piglets. Anesth Anal. 2009; 108(4):1268-1277.
Kurth CD, Levy WJ, McCann J: Near-infrared spectroscopy cerebral oxygen saturation thresholds for hypoxia-ischemia in piglets. J Cereb Blood Flow Metab 2002; 22:335-341.
Austin EH, Edmonds HL, Auden SM, et al. Benefit of Neurophysiologic Monitoring for Pediatric Cardiac Surgery. J Thorac Cardiovasc Surg. 1997; 114(5):707-717.
Fortune PM, Wagstaff M, Petros AJ. Cerebro-spanchnic oxygenation ratio (CSOR) using near infrared spectroscopy may be able to predict splanchnic ischaemia in neonates. Intensive Care Med. 2001; 27:1401-1407.
Kussman BD, Wypij D, Laussen PC, et al. Relationship of intraoperative cerebral oxygen saturation to neurodevelopmental outcome and brain magnetic resonance imaging at 1 year of age in infants undergoing biventricular repair. Circulation. 2010; 122:245-254.
Torella F, Cowley RD, Thorniley MS, McCollum CN. Regional Tissue Oxygenation During Hemorrhage: Can Near Infrared Spectroscopy be Used to Monitor Blood Loss? Shock. 2002; 18(5):440-444.
References Hansen SJ, Berens RJ, Havens PL, Kim MK, Hoffman GM. Effect of Volume
Resuscitation on Regional Perfusion in Dehydrated Pediatric Patients as Measured by Two-Site Near-Infrared Spectroscopy. Pediatric Emergency Care. 2009; 25(3):150-153.
Payen D, Luengo C, Heyer L, et al. Is thenar tissue hemoglobin oxygen saturation in septic shock related to macrohemodynamic variables and outcome? Crit Care. 2009; 13(5).
Kasman N, Brady K. Cerebral oximetry for pediatric anesthesia: why do intelligent clinicians disagree? Pediatric Anesthesia. 2011; 21(5):473-8.
Troianos CA. Cerebral Oximetry May Provide Helpful Information. Anesthesia Patient Safety Foundation Newsletter. 2004; 24(1). (Accessed at www.aspf.org)
Slater JP, Guarino T, Stack J, et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg 2009;87:36-45.
Yao FS, Tseng CC, Ho CY, et al. Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2004;18:552-8.
Casati A, Fanelli G, Pietropaoli P, et al. Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth Analg 2005;101:740-7.
Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg 2007;104:51-8.
References Tobias JD. Cerebral oximetry monitoring with near infrared spectroscopy detects
alterations in oxygenation before pulse oximetry. J Intensive Care Med 2008;23:384-8.
Tighe PJ, Elliott CE, Lucas SD, Boezaart AP. Noninvasive tissue oxygen saturation determined by near-infrared spectroscopy following peripheral nerve block. Acta Anaesthesiol Scand. 2011; 55:1239-1246.
Kane I, et al. Cerebral oxygen saturation monitoring in pediatric altered mental status patients. American Journal of Emergency medicine. 2014; 32:356-352.
Dewhirst ED, Winch P, Naguib A, Galantowicz M, Tobias JD. Cerebral Oximetry Monitoring During Preoperative Phlebotomy to Limit Allogenic Blood Use in Patients Undergoing Cardiac Surgery. Pediatr Cardiol. 2013; 34:75-80.
Pellicer A, et al. The SafeBoosc Phase II Randomised Clinical Trial: A Treatment Guideline for Targeted Near-Infrared-Derived Cerebral Tissue Oxygenation versus Standard Treatment in Extremely Preterm Infants. Neonatology. 2013;104:171-178.
Related Documents
