Absolute Versus Relative Near-Infrared Spectroscopy in Pediatric Cardiac Patients

Near infrared spectroscopy in the pediatric cardiac intensive care unit: accurately interpreting the data

PURPOSE OF REVIEW

Near infrared spectroscopy (NIRS) has been increasingly adopted as standard monitoring in postoperative care of pediatric cardiac patients. Several reports have established its association with both markers of perfusion and adverse outcomes. The correlation with markers of perfusion is not strong and exhibits wide limit of agreement, making the determination of critical thresholds and its integration in treatment algorithms challenging.

RECENT FINDINGS

A growing body of literature support the use of NIRS for hemodynamic monitoring in pediatric cardiac patients. Recent reports corroborate prior findings of weak to moderate correlation of NIRS with markers of global and regional perfusion and confirm its association with adverse outcomes. The challenge of lack of treatment thresholds remains, limiting clinical utility. Evidence of improvement of outcomes with the use of NIRS remains limited.

SUMMARY

NIRS is a useful monitor of regional and global perfusion and can inform management decisions but cannot be used as the sole decision-making tool. Large, randomized studies are needed to define its use as decision making tool and facilitate its integration in treatment algorithms.

The Year in Review: Anesthesia for Congenital Heart Disease 2023

This review highlights published literature in 2023 that is related to the anesthetic management of patients with congenital heart disease (CHD). Though not inclusive of all topics, 31 articles are discussed and four primary themes emerged: transfusion and hemostasis, outcomes and risk assessment, monitoring, and pharmacology.