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. 2023 Mar 1;24(3):204-212.
doi: 10.1097/PCC.0000000000003118. Epub 2022 Dec 13.

Absolute Versus Relative Near-Infrared Spectroscopy in Pediatric Cardiac Patients

Ilias Iliopoulos  1 , David S Cooper  1 , James A Reagor  1 , Wonshill Koh  1 , Bryan H Goldstein  1 , Philip R Khoury  1 , David L S Morales  2 , Sarosh Batlivala  1
Affiliations

Absolute Versus Relative Near-Infrared Spectroscopy in Pediatric Cardiac Patients

Ilias Iliopoulos et al. Pediatr Crit Care Med. .

Abstract

Objectives: Near-infrared spectroscopy (NIRS) has been increasingly accepted as a noninvasive marker of regional tissue oxygenation despite concerns of imprecision and wide limits of agreement (LOA) with invasive oximetry. New generation absolute monitors may have improved accuracy compared with trend monitors. We sought to compare the concordance with invasive venous oximetry of a new generation absolute NIRS-oximeter (FORESIGHT ELITE; CASMED, Branford, CT) with a modern widely used trend monitor (INVOS 5100C; Medtronic, Minneapolis, MN).

Design: Prospective single-center study.

Setting: Tertiary pediatric heart center.

Patients: Children undergoing elective cardiac catheterization under general anesthesia. Time-paired venous oximetry samples (jugular and renal) were compared with NIRS-derived oximetry by two monitors using regression and Bland-Altman analysis.

Interventions: None.

Measurements and main results: We enrolled 36 children (19 female, 10 cyanotic) with median age 4.1 years (25-75%, 2.5-7.8 yr) and weight 16.7 kg (12.3-29.1 kg). The absolute difference between NIRS-derived and invasive jugular oximetry was less than 10% in 67% of occasions for both monitors. Correlation was fair (Spearman rs = 0.40; p = 0.001) for the FORESIGHT ELITE and poor ( rs = 0.06; p = 0.71) for the INVOS 5100C. Bias and LOA were +6.7% (+22%, -9%) versus +1.3% (LOA = +24%, -21%), respectively. The absolute difference between NIRS-derived and invasive renal oximetry was less than 10% in 80% of occasions with moderate correlation ( rs = 0.57; p < 0.001) for the FORESIGHT ELITE and in 61% of occasions with moderate correlation ( rs = 0.58; p < 0.001) for the INVOS 5100C; bias and LOA were +3.6% (+19%, -12%) and -1.4 % (+27%, -30%), respectively. NIRS correlation with renal venous oximetry was worse for cyanotic versus noncyanotic patients ( p = 0.02).

Conclusions: Concordance and LOA of NIRS-derived oximetry with invasive venous oximetry in the cerebral and renal vascular beds was suboptimal for clinical decision-making. Cyanosis adversely affected NIRS performance in the renal site.

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Conflict of interest statement

Dr. Iliopoulos disclosed that the FORESIGHT ELITE Monitor and sensors were provided by CAS Medical Systems, Branford, Connecticut, free of charge for the duration of the study. Drs. Cooper and Goldstein received funding from Medtronic. Dr. Goldstein reports consulting relationships with Medtronic, W. L. Gore & Associates, Mezzion Pharma and PECA Labs. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

References

    1. Zaleski KL, Kussman BD: Near-infrared spectroscopy in pediatric congenital heart disease. J Cardiothorac Vasc Anesth. 2020; 34:489–500
    1. Flechet M, Güiza F, Vlasselaers D, et al.: Near-infrared cerebral oximetry to predict outcome after pediatric cardiac surgery: A prospective observational study. Pediatr Crit Care Med. 2018; 19:433–441
    1. Gottlieb EA, Fraser CD, Andropoulos DB, et al.: Bilateral monitoring of cerebral oxygen saturation results in recognition of aortic cannula malposition during pediatric congenital heart surgery. Paediatr Anaesth. 2006; 16:787–789
    1. Li J, van Arsdell GS, Zhang G, et al.: Assessment of the relationship between cerebral and splanchnic oxygen saturations measured by near-infrared spectroscopy and direct measurements of systemic haemodynamic variables and oxygen transport after the Norwood procedure. Heart. 2006; 92:1678–1685
    1. Rao R: Is change in regional (somatic) near-infrared spectroscopy not a useful indictor of clinically detectable low cardiac output in children after surgery for congenital heart defects? Pediatr Crit Care Med. 2013; 14:340–341

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