Cerebral Oximetry in Children

Cerebral baseline optical and hemodynamic properties in pediatric population: a large cohort time-domain near-infrared spectroscopy study

Significance

Reference cerebral near-infrared spectroscopy (NIRS) data on the pediatric population are scarce, and in most cases, only cerebral oxygen saturation (SO 2 ) measured by continuous wave spatially resolved spectroscopy NIRS is reported. Absolute data for baseline optical and hemodynamic parameters are missing.

Aim

We aimed at collecting baseline cerebral optical parameters [absorption coefficient,μ a ; reduced scattering coefficient,μ s ' ; differential pathlength factor (DPF)] and hemodynamic parameters [oxy-hemoglobin content (HbO 2 ), deoxyhemoglobin content (HHb), total hemoglobin content (tHB),SO 2 ] in a large cohort of pediatric patients. The objectives are to establish reference optical values in this population and evaluate the reproducibility of a commercial time domain (TD) NIRS tissue oximeter.

Approach

TD NIRS measurements were performed in the prefrontal cortex at 686 and 830 nm with a 2.5-cm source-detector distance and 1-Hz acquisition rate. Five independent measurements (after probe replacement) were taken for every subject. TD NIRS data were fitted to a photon diffusion model to estimate the optical parameters. From the absorption coefficients, the hemodynamic parameters were derived by Beer's law. Auxological and physiological information was also collected to explore the potential correlations with NIRS data.

Results

We measured 305 patients in the age range of 2 to 18 years. Absolute values for baseline optical and hemodynamic parameters were shown as a function of age and auxological variables. From the analysis of the repositioning after probe replacement, the time-domain near-infrared spectroscopy device exhibited an average precision (intended as coefficient of variation) of < 5 % forμ s ' , DPF,HbO 2 , HHb, and tHb, whereas precision was < 2 % forSO 2 .

Conclusions

We provided baseline values for optical and hemodynamic parameters in a large cohort of healthy pediatric subjects with good precision, providing a foundation for future investigations into clinically relevant deviations in these parameters.

The effect of hyperventilation versus normoventilation on cerebral oxygenation using near infrared spectroscopy in children undergoing posterior fossa tumor resection: A randomized controlled cross-over trial

BACKGROUND

This study aims to compare the effect of two different ventilation strategies on cerebral oxygenation in children undergoing posterior fossa tumor excision surgeries.

METHODS

Children scheduled for posterior fossa tumor surgeries were enrolled in this randomized, double-blinded, controlled cross-over trial. After induction of general anesthesia and positioning, participants were randomized to have mild hyperventilation for 30 min (phase 1) followed by normal ventilation for another 30 min (phase2) (early hyperventilation group, n = 23), or normal ventilation for 30 min (phase 1) followed by hyperventilation for 30 min (phase 2) (early normoventilation group, n = 19). Our primary outcome was cerebral oxygenation, measured using near-infrared spectroscopy (NIRS). Other outcomes included the intracranial pressure (ICP), brain relaxation score at the end of phase 1, and frequency of nadir NIRS.

RESULTS

Forty-two children were available for final per protocol analysis. The cerebral oxygenation decreased after the hyperventilation phase compared to the baseline values and the corresponding phases of normoventilation. The mean difference [95% confidence intervals (CI)] in cerebral oxygen saturation between the hyperventilation and normal ventilation readings was 13.45 ± 1.14% [11.14-15.76] and 11.47 ± 0.96% [11.14-15.76] in the left and right sides, respectively (p-values <0.0001). Both carryover and period effects were not significant. The ICP at the end of phase 1 did not differ between the two groups: 22.12 ± 3.75 mmHg vs. 23.26 ± 4.33, mean difference [95%CI]: -0.78 [-3.05 to 1.5], p = 0.49. Brain relaxation score was similar in the two groups.

CONCLUSION

In children undergoing posterior fossa craniotomy, moderate hyperventilation reduced cerebral oxygenation without significant improvement of the surgical brain relaxation or the ICP.

Validation of the Masimo O3™ regional oximetry device in pediatric patients undergoing cardiac surgery

We assessed the accuracy of Masimo O3™ regional cerebral oxygen saturation (rSO₂) readings by comparing them with reference values and evaluated the relationship between rSO₂ and somatic tissue oxygen saturation (StO₂) in children undergoing cardiac surgery. After anesthesia induction, pediatric sensors were applied to the forehead and foot sole, and rSO₂ and StO₂ values were monitored continuously. Before cardiopulmonary bypass (CPB), F_IO₂ was set to 0.2, 0.5, and 0.8 serially every 15 min. After CPB, F_IO₂ was reversed. The reference values (SavO₂) were calculated by combining arterial (SaO₂) and central venous oxygen saturation (SvO₂) readings from the arterial and central lines, respectively (0.7 [Formula: see text] SvO₂ + 0.3 [Formula: see text] SaO₂). In total, 265 pairs of rSO₂/StO₂ and SavO₂ from 49 patients were analyzed. The bias, standard deviation (SD), standard error (SE), and root mean squared error (RMSE) of rSO₂ were 2.6%, 4.5%, 0.3%, and 4.3%, respectively. The limits of agreement ranged from -6.3% to 11.6%. Trend accuracy analysis yielded a relative mean error of -1.4%, with an SD of 4.3%, SE of 0.2%, and RMSE of 3.9%. According to multiple linear regression analysis, the application of CPB, F_IO₂, Hb level, and tip location of the central venous catheter influenced the bias (all P < 0.05). Furthermore, the correlation between rSO₂ and StO₂ was weak (r = 0.254). rSO₂ readings by the Masimo O3™ device and pediatric sensor had good absolute and trending accuracies with respect to the calculated reference values in children undergoing cardiac surgery. rSO₂ and StO₂ cannot be used interchangeably.Clinical trial registration http://clinicaltrials.gov (number: NCT04208906).