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. 2025 Aug 30.
doi: 10.1007/s10047-025-01524-9. Online ahead of print.

Prediction of acute lung injury/acute respiratory distress syndrome after cardiopulmonary bypass in infants by monitoring femoral oxygen saturation

Kenta Matsui  1   2 , Norihiko Oka  3   4 , Fumiaki Shikata  5 , Satoshi Kohira  6 , Tadashi Kitamura  5 , Toshiaki Mishima  5 , Masaomi Fukuzumi  5 , Ryoichi Kondo  5 , Yusuke Motoji  5 , Yoshimi Tamura  5 , Saya Ishikawa  5 , Kiyotaka Fujii  6 , Masami Fujii  6 , Kagami Miyaji  5
Affiliations

Prediction of acute lung injury/acute respiratory distress syndrome after cardiopulmonary bypass in infants by monitoring femoral oxygen saturation

Kenta Matsui et al. J Artif Organs. .

Abstract

To investigate the feasibility of regional oxygen saturation (rSO2) monitoring for preventing acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) caused by cardiopulmonary bypass (CPB) in infants undergoing ventricular septal defect (VSD) closure. This study included 49 infants who underwent VSD closure between January 2012 and December 2023. Patients with preoperative pulmonary hypertension were excluded. rSO2 of the head, abdomen, and thigh was monitored perioperatively. ALI/ARDS was defined as a PaO2/FiO2 ratio (P/F ratio) ≤ 300 upon pediatric intensive care unit (PICU) admission. The median age at surgery was 4 (interquartile range: 3-5) months, and the median weight was 6.03 (interquartile range: 5.30-6.78) kg. Five (10%) patients developed postoperative ALI/ARDS and had a longer PICU stay (8 vs 5 days, P < 0.001) and hospital stay (10 vs 5 days, P = 0.005). According to multiple regression analysis, thigh rSO2 during CPB was a significant predictor of postoperative P/F ratio (β: 4.88, standard error: 1.99, P = 0.02). Receiver operating characteristic curve analysis showed that thigh rSO2 during CPB (area under the curve: 0.87, P = 0.01) significantly predicted postoperative ALI/ARDS. The optimal cutoff value for thigh rSO2 was 71%, with a sensitivity of 80% and specificity of 93%. Thigh rSO2 monitoring during CPB may be effective for detecting ALI/ARDS in infants who underwent VSD closure. Maintaining rSO2 levels above 71% might help prevent the onset of ALI/ARDS.

Keywords: ALI/ARDS; Cardiopulmonary bypass; Regional oxygen saturation.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval: Details of the informed consent process for all participants who were enrolled in this research are provided in a separate section of the manuscript. The study was approved by the institutional committee on human research (approval number: B24-028), and the research protocol was considered acceptable by the committee. Informed consent: As this was an observational study utilizing existing medical records and biological samples, neither written nor verbal consent was obtained from the participants. However, to provide the participants (or their legal guardians) with the opportunity to opt out, information about the study was made publicly available on the websites of the Department of Cardiovascular Surgery, Kitasato University School of Medicine, and the Ethics Committee. If a participant requested excluded, the relevant data and samples were removed or destroyed and not included in the analysis.

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