Role of intraoperative regional oxygen saturation using near infrared spectroscopy in the prediction of low output syndrome after pediatric heart surgery

J Card Surg. 2013 Jul;28(4):446-52. doi: 10.1111/jocs.12122. Epub 2013 Jun 5.


Background: We report on the applicability of intraoperative regional oxygen saturation (rSO2) desaturation score by near-infrared spectroscopy in the early detection of postoperative low output state (LOS) in infants with congenital heart disease who underwent cardiac surgery.

Materials and methods: Between July and October 2011 the intra- and immediate postoperative courses of 22 patients undergoing elective cardiac surgery for congenital heart disease were analyzed. The intraoperative cerebral and somatic rSO2 were measured and a rSO2 desaturation score calculated (by multiplying the rSO2 below 50% of the threshold by seconds). The aim of the study was to evaluate the applicability of intraoperative rSO2 de-saturation score in the early detection of postoperative LOS.

Results: Thirteen of 22 patients (62%) had an intraoperative cerebral rSO2 desaturation score >3000% per second. Patients with a rSO2 de-saturation score >3000% per second had a significantly lower intraoperative central venous saturation (SvO2, p = 0.002), cardiac index (CI, p = 0.004), oxygen availability indexed (DO2I, p = 0.0004), and a significantly higher extraction of oxygen (ERO2, p = 0.0005) when compared to patients with a rSO2 desaturation score <3000% per second. Nine patients had postoperative LOS; all of them had an intraoperative rSO2 de-saturation score >3000% per second (9/13 patients, 69%; p = 0.001) requiring prompt treatment with major inotropic support, surface hypothermia, and extracorporeal membrane oxygenation (ECMO) support (n = 4). Twenty-one patients survived. One patient died from ventricular failure and inability to wean from ECMO support.

Conclusion: The intraoperative use of NIRS provided an early warning sign of hemodynamic or metabolic compromise, enabling early and rapid intervention to prevent or reduce the severity of potentially life-threatening complications.

MeSH terms

  • Cardiac Output, Low / diagnosis*
  • Cardiac Output, Low / prevention & control
  • Cardiac Output, Low / therapy
  • Cardiac Surgical Procedures*
  • Child
  • Child, Preschool
  • Female
  • Forecasting
  • Heart Defects, Congenital / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Monitoring, Intraoperative / methods*
  • Oximetry / methods*
  • Perioperative Care
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / prevention & control
  • Postoperative Complications / therapy
  • Spectroscopy, Near-Infrared*
  • Syndrome