First Characterization of Tissue Oxygen Saturation Recovery Patterns in Pediatric Cardiac Surgery Patients Undergoing Remote Ischemic Preconditioning and the Association With Clinical Outcomes

Abstract

Objective: This study aimed to delineate the recovery patterns of regional oxygen saturation (SrO₂) in pediatric cardiac surgery patients subjected to remote ischemic preconditioning (RIPC), utilizing near-infrared spectroscopy (NIRS) for quantification. It also sought to establish the correlation between these perfusion patterns and postoperative clinical outcomes.

Design: A prospective longitudinal observational study.

Setting: The study was conducted at Fundación Valle Del Lili, a high-complexity service provider institution in Fundación Valle Del Lili.

Participants: Pediatric patients (younger than 18 years of age) scheduled for elective cardiac surgery requiring cardiopulmonary bypass between August 2022 and July 2023.

Interventions: RIPC was performed after anesthetic induction, involving cycles of ischemia and reperfusion on a lower limb. Monitoring included SrO₂ using NIRS.

Measurements and main results: The study identified 4 distinct patterns of SrO₂ during RIPC. Findings demonstrated a significant association between the negative SrO₂ pattern and increased postoperative adverse events, including extended hospital stays and higher mortality, while a positive pattern was associated with better outcomes.

Conclusions: Specific patterns of SrO₂ response to RIPC may serve as important indicators for risk stratification in congenital heart surgery. This study illustrated the potential of NIRS in detecting hypoxic states and predicting postoperative outcomes, emphasizing the need for standardized clinical interpretation of RIPC patterns.

Keywords: cerebral oxygen saturation; congenital heart surgery; near-infrared spectroscopy; postoperative outcomes; preconditioning; regional oxygen saturation.