Clinical Reports

Pediatric Clinical Reports and Abstracts

This section is intended to provide you clinical reports for the INVOS Cerebral Oximeter.
We will update this section with abstracts and other Clinical Reports, as they become available.

A link to the document is provided when available. These links may take you to
another site such as PubMed.

Pediatric Surgery

Andropoulos DB, Diaz LK, Fraser CD, McKenzie ED, Stayer SA. Is bilateral monitoring of
cerebral oxygen saturation necessary during neonatal aortic arch reconstruction? Anesth Analg
2004;98:1267-72. [Abstract] [PubMed]

Hoffman GM, Stuth EA, Jaquiss RD, Vanderwal PL, Staudt SR, Troshynski TJ, Ghanayem NS,
Tweddell JS. Changes in cerebral and somatic oxygenation during stage 1 palliation of
hypoplastic left heart syndrome using continuous regional cerebral perfusion. J Thorac
Cardiovasc Surg 2004;127:223-33. [Abstract] [PubMed]

Tosone SR, Miller BE, Guzzetta NA, Kanter KR, Forbess JM. Cerebral oxygen saturation
monitoring is a useful adjunct in assessing adequacy of systemic perfusion in single ventricle
physiology after neonatal cardiac surgery. Anesthesiology 2003;99:A1392.* [Abstract]

Yeh T Jr, Austin EH III, Sehic A, Edmonds HL Jr. Rapid recognition and treatment of
cerebral air embolism: The role of neuromonitoring. J Thorac Cardiovasc Surg 2003;126:589-91.
[Case Report] [PubMed]

deVries JW, Hanschoten MC. Resuscitation in pediatric balloon valvuloplasty: effects on cerebral
perfusion and oxygenation. J Cardiothorac Vasc Anesth 2000;14:581-583. [Case Report]

Pigula FA, Nemoto EM, Griffith BP, Siewers RD. Regional low-flow perfusion provides cerebral
circulatory support during neonatal aortic arch reconstruction. J Thorac Cardiovasc Surg
2000;119:331-9. [Abstract] [PubMed]

Daubeney PEF, Smith DC, Pilkington SN, Lamb RK, Monro JL, Tsang VT, Livesey SA,
Webber SA. Cerebral oxygenation during paediatric cardiac surgery: identification of vulnerable
periods using near infrared spectroscopy. Eur J Cardiothorac Surg 1998;13:370-377.
[Abstract] [PubMed]

Austin EH, Edmonds HL, Auden SM, Seremet V, Niznic G, Sehic A, Sowell MK, Cheppo CD,
Corlett KM. Benefit of neurophysiologic monitoring for pediatric cardiac surgery. J Thorac
Cardiovasc Surg 1997;114:707-17. [Abstract] [PubMed]

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Anesth Analg. 2004 May;98(5):1267-72.

Is bilateral monitoring of cerebral oxygen saturation necessary
during neonatal aortic arch reconstruction?

Andropoulos DB, Diaz LK, Fraser CD Jr, McKenzie ED, Stayer SA.

Department of Anesthesiology, Baylor College of Medicine, and Division of
Pediatric Cardiovascular Anesthesiology, Texas Children's Hospital, Houston,
Texas 77030, USA. dra@bcm.tmc.edu

In this study, we measured cerebral oxygenation in both cerebral hemispheres by
using near-infrared spectroscopy before, during, and after regional low-flow
cerebral perfusion (RLFP) to determine whether bilateral monitoring was
necessary. Neonates undergoing aortic arch reconstruction with RLFP were
studied. The bilateral regional cerebral oxygenation index was measured and
recorded at 1-min intervals during the following periods: 1) before bypass, 2)
during bypass before RLFP, 3) during RLFP, 4) on bypass after RLFP, and 5)
post-bypass. Before bypass and on bypass before RLFP, the correlation (r = 0.979
and 0.852) and agreement (mean bias, right versus left, 0 and +2) between
hemispheres were excellent. During RLFP, however, correlation (r = 0.35) and
agreement (mean bias of the right versus left side, +6.3) worsened and only
partially returned to baseline values after RLFP. Nine of 19 patients had sustained
differences in cerebral oxygen saturation of >10%, always with the left side
values less than the right. Bilateral monitoring detects desaturation in the left
cerebral hemisphere during RLFP. The long-term consequences of lower
saturations on the left side of the brain are unclear. IMPLICATIONS: Left-sided
cerebral hemisphere oxygen saturation, measured with near-infrared
spectroscopy, was less than right-sided cerebral oxygen saturation during regional
low-flow cerebral perfusion used for neonatal aortic arch reconstruction.

Publication Types:
• Clinical Trial

PMID: 15105198 [PubMed - indexed for MEDLINE]

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J Thorac Cardiovasc Surg. 2004 Jan;127(1):223-33.

Changes in cerebral and somatic oxygenation during stage 1
palliation of hypoplastic left heart syndrome using continuous
regional cerebral perfusion.

Hoffman GM, Stuth EA, Jaquiss RD, Vanderwal PL, Staudt SR,
Troshynski TJ, Ghanayem NS, Tweddell JS.

Department of Pediatric Anesthesiology, Children's Hospital of Wisconsin and
Medical College of Wisconsin, Milwaukee 53226, USA.

OBJECTIVES: Stage 1 palliation of hypoplastic left heart syndrome requires the
interruption of whole-body perfusion. Delayed reflow in the cerebral circulation
secondary to prolonged elevation in vascular resistance occurs in neonates after
deep hypothermic circulatory arrest. We examined relative changes in cerebral
and somatic oxygenation with near-infrared spectroscopy while using a modified
perfusion strategy that allowed continuous cerebral perfusion. METHODS: Nine
neonates undergoing stage 1 palliation for hypoplastic left heart syndrome had
regional tissue oxygenation continuously measured by frontal cerebral and
thoraco-lumbar (T10-L2) somatic (renal) reflectance oximetry probes (rSO(2),
INVOS; Somanetics, Troy, Mich). Surgery was accomplished using
cardiopulmonary bypass with whole-body cooling (18 degrees C-20 degrees C)
and regional cerebral perfusion through the innominate artery at flow rates guided
by estimated minimum flow requirements and measured rSO(2) during
reconstruction of the aortic arch. Data were logged at 1-minute intervals and
analyzed using repeated measures analysis of variance. RESULTS: A total of
3176 minutes of data were analyzed. Prebypass cerebral rSO(2) was 65.4 +/- 8.9,
and somatic rSO(2) was 58.9 +/- 12.4 (P <.001, cerebral vs somatic). During
regional cerebral perfusion, cerebral rSO(2) was 80.7 +/- 8.6, and somatic rSO(2)
was 41.4 +/- 7.1 (P <.001). Postbypass cerebral rSO(2) was 53.2 +/- 14.9, and
somatic rSO(2) was 76.4 +/- 7.7 (P <.001). The risk of cerebral desaturation was
significantly increased after cardiopulmonary bypass. CONCLUSIONS: Cerebral
oxygenation was maintained during regional cerebral perfusion at prebypass
levels with deep hypothermia. However, after rewarming and separation from
cardiopulmonary bypass, cerebral oxygenation was lower compared with
prebypass or somatic values. These results indicate that cerebrovascular resistance
is increased after deep hypothermic cardiopulmonary bypass, even with
continuous perfusion techniques, placing the cerebral circulation at risk
postoperatively.

PMID: 14752434 [PubMed - indexed for MEDLINE]

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J Thorac Cardiovasc Surg. 2000 Feb;119(2):331-9.

Regional low-flow perfusion provides cerebral circulatory support
during neonatal aortic arch reconstruction.

Pigula FA, Nemoto EM, Griffith BP, Siewers RD.

Department of Pediatric Cardiothoracic Surgery, Children's Hospital of
Pittsburgh, Pittsburgh, PA 15213, USA.

OBJECTIVE: Because of concerns regarding the effects of deep hypothermia and
circulatory arrest on the neonatal brain, we have developed a technique of
regional low-flow perfusion that provides cerebral circulatory support during
neonatal aortic arch reconstruction. METHODS: We studied the effects of
regional low-flow perfusion on cerebral oxygen saturation and blood volume as
measured by near-infrared spectroscopy in 6 neonates who underwent aortic arch
reconstruction and compared these effects with 6 children who underwent cardiac
repair with deep hypothermia and circulatory arrest. RESULTS: All the children
survived with no observed neurologic sequelae. Near-infrared spectroscopy
documented significant decreases in both cerebral blood volume and oxygen
saturations in children who underwent repair with deep hypothermia and
circulatory arrest as compared with children with regional low-flow perfusion.
Reacquisition of baseline cerebral blood volume and cerebral oxygen saturations
were accomplished with a regional low-flow perfusion rate of 20 mL x kg(-1) x
min(-1). CONCLUSIONS: Regional low-flow perfusion is a safe and simple
bypass management technique that provides cerebral circulatory support during
neonatal aortic arch reconstruction. The reduction of deep hypothermia and
circulatory arrest time required may reduce the risk of cognitive and psychomotor
deficits.

PMID: 10649209 [PubMed - indexed for MEDLINE]

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Eur J Cardiothorac Surg. 1998 Apr;13(4):370-7.

Cerebral oxygenation during paediatric cardiac surgery:
identification of vulnerable periods using near infrared spectroscopy.

Daubeney PE, Smith DC, Pilkington SN, Lamb RK, Monro JL, Tsang VT,
Livesey SA, Webber SA.

Wessex Cardiothoracic Centre, Southampton General Hospital, UK.

OBJECTIVE: Neurologic sequelae remain a well recognised complication of
paediatric cardiac surgery. Monitoring of cerebral oxygenation may be a useful
technique for identifying vulnerable periods for the development of neurologic
injury. We sought to measure regional cerebral oxygenation in children
undergoing cardiac surgery using near infrared spectroscopy to ascertain such
vulnerable periods. METHODS: Observational study of 18 children (median age
1.3 years) undergoing cardiac surgery (17 with cardiopulmonary bypass, 8 with
circulatory arrest). Regional cerebral oxygenation was monitored using the
INVOS 3100 cerebral oximeter and related to haemodynamic parameters at each
stage of the procedure. RESULTS: Prior to the onset of bypass, 10 patients had a
decrease in regional cerebral oxygenation of > or = 15% points, reaching an
absolute haemoglobin saturation less than 35% in 5 cases. The most common
cause was handling and dissection around the heart prior to and during caval
cannulation. With institution of bypass, regional cerebral oxygenation increased
by a mean 18% points to a mean maximum of 75%. During circulatory arrest
regional cerebral oxygenation decreased with rate of decay influenced by
temperature at onset of arrest (0.25%/min at < 20 degrees C; 2%/min at > 20
degrees C). Reperfusion caused an immediate increase in regional cerebral
oxygenation followed by a decrease during rewarming. Discontinuation of bypass
caused a precipitous decrease in regional cerebral oxygenation in 5 patients,
reaching less than 50% in 3 patients. CONCLUSIONS: These observations
suggest that the pre- and early post-bypass periods are vulnerable times for
provision of adequate cerebral oxygenation. Near infrared spectroscopy is a
promising tool for monitoring O2 supply/demand relationships especially during
circulatory arrest.

PMID: 9641334 [PubMed - indexed for MEDLINE]

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J Thorac Cardiovasc Surg. 1997 Nov;114(5):707-15, 717; discussion 715-6.

Benefit of neurophysiologic monitoring for pediatric cardiac surgery.

Austin EH 3rd, Edmonds HL Jr, Auden SM, Seremet V, Niznik G, Sehic A,
Sowell MK, Cheppo CD, Corlett KM.

Department of Surgery, University of Louisville School of Medicine, Ky., USA.

BACKGROUND: Pediatric patients undergoing repair of congenital cardiac
abnormalities have a significant risk of an adverse neurologic event. Therefore
this retrospective cohort study examined the potential benefit of interventions
based on intraoperative neurophysiologic monitoring in decreasing both
postoperative neurologic sequelae and length of hospital stay as a cost proxy.
METHODS: With informed parental consent approved by the institutional review
board, electroencephalography, transcranial Doppler ultrasonic measurement of
middle cerebral artery blood flow velocity, and transcranial near-infrared cerebral
oximetry were monitored in 250 patients. An interventional algorithm was used to
detect and correct specific deficiencies in cerebral perfusion or oxygenation or to
increase cerebral tolerance to ischemia or hypoxia. RESULTS: Noteworthy
changes in brain perfusion or metabolism were observed in 176 of 250 (70%)
patients. Intervention that altered patient management was initially deemed
appropriate in 130 of 176 (74%) patients with neurophysiologic changes. Obvious
neurologic sequelae (i.e., seizure, movement, vision or speech disorder) occurred
in five of 74 (7%) patients without noteworthy change, seven of 130 (6%) patients
with intervention, and 12 of 46 (26%) patients without intervention (p = 0.001).
Survivors' median length of stay was 6 days in the no-change and intervention
groups but 9 days in the no-intervention group. In addition, the percentage of
patients in the no-intervention group discharged from the hospital within 1 week
(32%) was significantly less than that in either the intervention (51%, p = 0.05) or
no-change (58%, p = 0.01) groups. On the basis of an estimated hospital
neurologic complication cost of $1500 per day, break-even analysis justified a
hospital expenditure for neurophysiologic monitoring of $2142 per case.
CONCLUSIONS: Interventions based on neurophysiologic monitoring appear to
decrease the incidence of postoperative neurologic sequelae and reduce the length
of stay. Inasmuch as the break-even cost for neurophysiologic monitoring is more
than four times the actual average charge, both patients and hospital may profit
from this service. Because this study was not a truly randomized clinical trial,
unintentional statistical bias may have occurred and caution is urged in
interpreting the magnitude of apparent intergroup outcome differences.

PMID: 9375600 [PubMed - indexed for MEDLINE]

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