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Preoperative cerebral and renal oxygen saturation and clinical outcomes in pediatric patients with congenital heart disease

  • Junichi SaitoEmail author
  • Daiki Takekawa
  • Jun Kawaguchi
  • Takuya Suganuma
  • Mao Konno
  • Satoko Noguchi
  • Takaharu Tokita
  • Eiji Hashiba
  • Kazuyoshi Hirota
Original Research

Abstract

We examined the predictability of preoperative cerebral and renal rSO2 values for outcomes in pediatric patients undergoing cardiac surgery under cardiopulmonary bypass (CPB). Patients who underwent pediatric cardiac surgery under CPB between September 2015 and September 2017 were enrolled in this study. Patients monitored with both cerebral and renal rSO2 at the beginning of surgery were included. The primary outcome was the prediction of outcomes after pediatric cardiac surgery. Outcome was defined as any of: (1) death within 30 days after surgery, or the need for (2) renal replacement therapy or (3) extracorporeal membrane oxygenation, (4) shorten mechanical ventilator-free day,(5) shorten ICU-free survival day. We included 59 patients: cyanotic n = 31; non-cyanotic n = 28. Among all patients, 15 (25%) had poor outcomes, including three deaths. The cerebral and renal rSO2 values were significantly lower in the cyanotic patients with poor outcomes compared to those without poor outcomes (cerebral: 59 ± 11 vs. 50 ± 5, p = 0.021; renal: 59 ± 15 vs. 51 ± 14, p = 0.015) but only the renal rSO2 value was significantly lower in the non-cyanotic patients (77 ± 10 vs. 61 ± 14, p = 0.011). The cut-off value (51%) of cerebral rSO2 were associated with risk of mechanical ventilator-free day and ICU-free survival day [ORs of 22.8 (95% CI 2.21–235.0, p = 0.0087) and 15.8 (95% CI 1.53–164.0, p = 0.0204), respectively] in the cyanotic patients. The cut-off value (66%) of cerebral rSO2 value was associated with risk of mechanical ventilator-free day [OR of 11.3 (95% CI 1.05–25.3, p = 0.0456)] and the cut-off value (66%) of renal rSO2 value was associated with risk of ICU-free survival day [ORs of 33.0 (95% CI 2.25–484.0, p = 0.0107)] in the noncyanotic patients. The preoperative low rSO2 values were associated with outcomes including 30-day mortality and might be reflective of the severity of cardiopulmonary function. Further studies are needed to confirm our results.

Keywords

Congenital heart disease Regional oxygen saturation Cardiopulmonary dysfunction Cerebrovascular autoregulation 

Notes

Author contributions

J.S. designed the study, collected the data, performed the statistical analysis and drafted the manuscript. D.K., J.K., T.S., M.S. collected the data and analysis the data. S.N., T.T. and E.H. collected and evaluated the data, revised the manuscript. K.H. designed the study, evaluated the data and extensively revised the manuscript.

Funding

This work was supported by the Department of Anesthesiology, Hirosaki University Graduate School of Medicine.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest. All authors read and approved the final manuscript and attest to the integrity of the original data and the analysis reported in this manuscript.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologyHirosaki University Graduate School of MedicineHirosakiJapan
  2. 2.Department of AnesthesiologyAomori Prefectural Central HospitalAomoriJapan
  3. 3.Division of Intensive Care UnitHirosaki University Graduate School of MedicineHirosakiJapan

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