Key result
Lower baseline cerebral oxygen saturation is linked to prolonged pediatric ICU stay after congenital cardiac surgery.
Why the study?
The association between baseline and intraoperative cerebral oxygen saturation and postoperative outcomes in pediatric congenital cardiac surgery was unclear.
Is baseline cerebral oxygen saturation associated with postoperative outcomes in pediatric patients undergoing congenital cardiac surgery?
Observational (n=565)
No
Is baseline cerebral oxygen saturation associated with postoperative outcomes in pediatric patients undergoing congenital cardiac surgery?
Low baseline cerebral oxygen saturation measured after tracheal intubation is associated with adverse postoperative outcomes in pediatric congenital cardiac surgery, whereas intraoperative desaturations are not.
Answers are grounded in this paper and cite their sources.
Baseline cerebral saturation after intubation was associated with adverse outcomes; leaves open whether targeted interventions improve results in pediatric congenital heart surgery.
Non-invasive cerebral oxygen saturation (ScO 2 ) monitoring is an established tool in the intraoperative phase of pediatric congenital cardiac surgery (CCS). This study investigated the association between ScO 2 and postoperative outcome by investigating both baseline ScO 2 values and intraoperative desaturations from baseline. All CCS procedures performed in the period 2010-2017 in our institution in which ScO 2 was monitored were included in this historical cohort study. Baseline ScO 2 was determined after tracheal intubation, before surgical incision. Subgroups were based on cardiac pathology and degree of intracardiac shunting. Poor outcome was defined based on length of stay (LOS) in the intensive care unit (ICU)/hospital, duration of mechanical ventilation (MV), and 30-day mortality. Intraoperatively, ScO 2 total time below baseline (TBBL) and ScO 2 time-weighted average (TWA) were calculated. Data from 565 patients were analyzed. Baseline ScO 2 was significantly associated with LOS in ICU (odds ratio [OR] per percentage decrease in baseline ScO 2 , 0.95; 95% confidence interval [CI], 0.93 to 0.97; P < 0.001), with LOS in hospital (OR, 0.93; 95% CI, 0.91 to 0.96; P < 0.001), with MV duration (OR, 0.92; 95% CI, 0.90 to 0.95; P < 0.001) and with 30-day mortality (OR, 0.94; 95% CI, 0.91 to 0.98; P = 0.007). Cerebral oxygen saturation TWA had no associations, while ScO 2 TBBL had only a small association with LOS in ICU (OR, 1.02; 95% CI, 1.01 to 1.03; P < 0.001), MV duration (OR,1.02; 95% CI, 1.01 to 1.03; P = 0.002), and LOS in hospital (OR, 1.02; 95% CI, 1.01 to 1.04; P < 0.001). In pediatric patients undergoing cardiac surgery, low baseline ScO 2 values measured after tracheal intubation were associated with several adverse postoperative outcomes. In contrast, the severity of actual intraoperative cerebral desaturation was not associated with postoperative outcomes. Baseline ScO 2 measured after tracheal intubation may help identify patients at increased perioperative risk.
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Modestini et al. (2020) conducted an observational in Congenital heart disease (n=565). Baseline cerebral oxygen saturation (ScO2) vs. Unexposed/reference (higher baseline ScO2) was evaluated on Prolonged length of stay in the intensive care unit (ICU) (OR 0.95, 95% CI 0.93-0.97, p=<0.001). Lower baseline cerebral oxygen saturation measured after tracheal intubation was significantly associated with prolonged intensive care unit stay (OR 0.95) and other adverse postoperative outcomes in pediatric patients undergoing congenital cardiac surgery.
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