First Characterization of Tissue Oxygen Saturation Recovery Patterns in Pediatric Cardiac Surgery Patients Undergoing Remote Ischemic Preconditioning and the Association With Clinical Outcomes

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 38; no. 6; pp. 1347 - 1352
• Main Authors: Vélez-Esquivia, Maria A., Pedroza, Santiago, Rivera, Richard, Camayo-Zorrilla, Juan, Cruz-Suárez, Gustavo A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2024
• Subjects: Adolescent; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; cerebral oxygen saturation; Child; Child, Preschool; congenital heart surgery; Female; Heart Defects, Congenital - surgery; Humans; Infant; Ischemic Preconditioning - methods; Longitudinal Studies; Male; near-infrared spectroscopy; Oxygen Saturation - physiology; postoperative outcomes; preconditioning; Prospective Studies; regional oxygen saturation; Spectroscopy, Near-Infrared - methods; Treatment Outcome; cerebral oxygen saturation; postoperative outcomes; near-infrared spectroscopy; regional oxygen saturation; congenital heart surgery; preconditioning
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2024.02.037

•Four recovery patterns of regional oxygen saturation in patients subjected to remote ischemic preconditioning (RIPC) were identified using near-infrared spectroscopy.•A negative regional oxygen saturation pattern correlates with higher post-operative complications.•RIPC pattern analysis offers a new risk stratification tool for congenital heart surgery.•This study illustrates the need for standardized clinical interpretation of RIPC patterns. This study aimed to delineate the recovery patterns of regional oxygen saturation (SrO2) in pediatric cardiac surgery patients subjected to remote ischemic preconditioning (RIPC), utilizing near-infrared spectroscopy (NIRS) for quantification. It also sought to establish the correlation between these perfusion patterns and postoperative clinical outcomes. A prospective longitudinal observational study. The study was conducted at Fundación Valle Del Lili, a high-complexity service provider institution in Fundación Valle Del Lili. Pediatric patients (younger than 18 years of age) scheduled for elective cardiac surgery requiring cardiopulmonary bypass between August 2022 and July 2023. RIPC was performed after anesthetic induction, involving cycles of ischemia and reperfusion on a lower limb. Monitoring included SrO2 using NIRS. The study identified 4 distinct patterns of SrO2 during RIPC. Findings demonstrated a significant association between the negative SrO2 pattern and increased postoperative adverse events, including extended hospital stays and higher mortality, while a positive pattern was associated with better outcomes. Specific patterns of SrO2 response to RIPC may serve as important indicators for risk stratification in congenital heart surgery. This study illustrated the potential of NIRS in detecting hypoxic states and predicting postoperative outcomes, emphasizing the need for standardized clinical interpretation of RIPC patterns.