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Near-infrared spectroscopy for prediction of extubation success after neonatal cardiac surgery

Published online by Cambridge University Press:  06 June 2019

Eleanor A. Gradidge Open the ORCID record for Eleanor A. Gradidge [Opens in a new window] ,
Lisa M. Grimaldi ,
Katherine Cashen ,
Keshava M. N. Gowda ,
Kurt D. Piggott ,
Michael Wilhelm ,
John M. Costello  and
Christopher W. Mastropietro
Eleanor A. Gradidge
Affiliation:
Department of Pediatrics, Ochsner Children’s Hospital, New Orleans, LA, USA
Lisa M. Grimaldi*
Affiliation:
Division of Cardiovascular Intensive Care, Phoenix Children’s Hospital and Department of Child Health, University of Arizona, College of Medicine - Phoenix, Phoenix, AZ, USA
Katherine Cashen
Affiliation:
Division of Critical Care, Department of Pediatrics, Wayne State University School of Medicine, Children’s Hospital of Michigan, Detroit, MI, USA
Keshava M. N. Gowda
Affiliation:
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Cleveland Clinic, Cleveland, OH, USA
Kurt D. Piggott
Affiliation:
Division of Pediatric Cardiac Intensive Care, Department of Pediatrics, Children’s Hospital New Orleans, Louisiana State University Health Sciences, New Orleans, LA, USA
Michael Wilhelm
Affiliation:
Division of Pediatric Cardiac Intensive Care, Department of Pediatrics, University of Wisconsin, Madison, WI, USA
John M. Costello
Affiliation:
Divisions of Cardiology & Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Christopher W. Mastropietro
Affiliation:
Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
*
Author for correspondence: L. M. Grimaldi, MD, Division of Cardiovascular Intensive Care, Phoenix Children’s Hospital, 1919 E. Thomas Rd., Phoenix, AZ 85016, USA. Tel: +1 (201) 410-2504; E-mail: [email protected]
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Abstract

Introduction:

Reliable predictors of extubation readiness are needed and may reduce morbidity related to extubation failure. We aimed to examine the relationship between changes in pre-extubation near-infrared spectroscopy measurements from baseline and extubation outcomes after neonatal cardiac surgery.

Materials and Methods:

In this retrospective cross-sectional multi-centre study, a secondary analysis of prospectively collected data from neonates who underwent cardiac surgery at seven tertiary-care children’s hospitals in 2015 was performed. Extubation failure was defined as need for re-intubation within 72 hours of the first planned extubation attempt. Near-infrared spectroscopy measurements obtained before surgery and before extubation in patients who failed extubation were compared to those of patients who extubated successfully using t-tests.

Results:

Near-infrared spectroscopy measurements were available for 159 neonates, including 52 with single ventricle physiology. Median age at surgery was 6 days (range: 1–29 days). A total of 15 patients (9.4 %) failed extubation. Baseline cerebral and renal near-infrared spectroscopy measurements were not statistically different between those who were successfully extubated and those who failed, but pre-extubation cerebral and renal values were significantly higher in neonates who extubated successfully. An increase from baseline to time of extubation values in cerebral oximetry saturation by ≥ 5 % had a positive predictive value for extubation success of 98.6 % (95%CI: 91.1–99.8 %).

Conclusion:

Pre-extubation cerebral near-infrared spectroscopy measurements, when compared to baseline, were significantly associated with extubation outcomes. These findings demonstrate the potential of this tool as a valuable adjunct in assessing extubation readiness after paediatric cardiac surgery and warrant further evaluation in a larger prospective study.

Keywords

Airway extubationcardiac surgerynear-infrared spectroscopyneonate
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 6 , June 2019 , pp. 787 - 792
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Copyright
© Cambridge University Press 2019 

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References

Baisch, SD, Wheeler, WB, Kurachek, SC, Cornfield, DN. Extubation failure in pediatric intensive care incidence and outcomes. Pediatr Crit Care Med 2005; 6: 312–318.CrossRefGoogle ScholarPubMed
Harkel, AD, van der Vorst, MM, Hazekamp, MG, Ottencamp, J. High mortality rate after extubation failure after pediatric cardiac surgery. Pediatr Cardiol 2005; 26: 756–761.CrossRefGoogle ScholarPubMed
Mastropietro, CW, Cashen, K, Grimaldi, LM, et al. Extubation failure after neonatal cardiac surgery: a multicenter analysis. J Pediatr 2017; 182: 190–196.CrossRefGoogle ScholarPubMed
Newth, CJ, Venkataraman, S, Willson, DF, et al. Weaning and extubation readiness in pediatric patients. Pediatr Crit Care Med 2009; 10: 1–11.CrossRefGoogle ScholarPubMed
Benneyworth, BD, Mastropietro, CW, Graham, EM, et al. Variation in extubation failure rates after neonatal congenital heart surgery across Pediatric Cardiac Critical Care Consortium hospitals. J Thoracic Cardiovasc Surg 2017; 153: 1519–1526.CrossRefGoogle ScholarPubMed
Harrison, AM, Cox, AC, Davis, S, Piedmonte, M, Drummond-Webb, JJ, Mee, RB. Failed extubation after cardiac surgery in young children: prevalence, pathogenesis, and risk factors. Pediatr Crit Care Med 2002; 3: 148–152.CrossRefGoogle ScholarPubMed
Ghanayem, NS, Hoffman, GM. Near infrared spectroscopy as a hemodynamic monitor in critical illness. Pediatr Crit Care Med 2016; 17: S201–S206.CrossRefGoogle ScholarPubMed
Foster, CB, Spaeder, MC, McCarter, RJ, Cheng, YI, Berger, JT. The use of near-infrared spectroscopy during an extubation readiness trial as a predictor of extubation outcome. Pediatr Crit Care Med 2013; 14: 587–592.CrossRefGoogle ScholarPubMed
Hoffman, GM, Ghanayem, NS, Scott, JP, Tweddell, JS, Mitchell, ME, Mussatto, KA. Postoperative cerebral and somatic near-infrared spectroscopy saturations and outcome in hypoplastic left heart syndrome. Ann Thorac Surg 2017; 103: 1527–1535.CrossRefGoogle ScholarPubMed
Hanson, SJ, Berens, RJ, Havens, PL, Kim, MK, Hoffman, GM. Effect of volume resuscitation on regional perfusion in dehydrated pediatric patients as measured by two-site near-infrared spectroscopy. Pediatr Emerg Care 2009; 25: 150–153.CrossRefGoogle ScholarPubMed
Nagdyman, N, Fleck, T, Schubert, S, et al. Comparison between cerebral tissue oxygenation index measure by near-infrared spectroscopy and venous jugular bulb saturation in children. Intensive Care Med 2005; 31: 846–850.CrossRefGoogle Scholar
Gaies, M, Tabbutt, S, Schwartz, SM, et al. Clinical epidemiology of extubation failure in the pediatric cardiac ICU: a report from the Pediatric Cardiac Critical Care Consortium. Pediatr Crit Care Med 2015; 16: 837–845.CrossRefGoogle ScholarPubMed
Kurachek, SC, Newth, CJ, Quasney, MW, et al. Extubation failure in pediatric intensive care: a multiple-center study of risk factors and outcomes. Crit Care Med 2003; 31: 2657–2664.CrossRefGoogle ScholarPubMed
Laudato, N, Gupta, P, Walters, HL, Delius, RE, Mastropietro, CW. Risk factors for extubation failure following neonatal cardiac surgery. Pediatr Crit Care Med 2015; 16: 859–867.CrossRefGoogle ScholarPubMed
Gupta, P, McDonald, R, Goyal, S, et al. Extubation failure in infants with shunt-dependent pulmonary blood flow and univentricular physiology. Cardiol Young 2014; 24: 64–72.CrossRefGoogle ScholarPubMed
Williams, J, McLean, A, Ahari, J, et al. Decreases in mixed venous blood O2 saturations in cardiac surgery patients following extubation. J Intensive Care Med 2017; 1: 885066617741435.Google Scholar
Paulus, S, Lehot, JJ, Bastien, O, Piriou, V, George, M, Estanove, S. Enoximone and acute left ventricular failure during weaning from mechanical ventilation after cardiac surgery. Crit Care Med 1994; 22: 74–80.CrossRefGoogle ScholarPubMed
Phelps, HM, Mahle, WT, Kim, D, et al. Postoperative cerebral oxygenation in hypoplastic heart syndrome after the Norwood procedure. Ann Thorac Surg 2009; 87: 1490–1494.CrossRefGoogle ScholarPubMed
Bhalala, US, Nishisaki, A, McQueen, D, et al. Change in regional (somatic) near-infrared spectroscopy is not a useful indicator of clinically detectable low cardiac output in children after surgery for congenital heart defects. Pediatr Crit Care Med 2012; 13: 529–534.CrossRefGoogle Scholar
Balaguru, D, Bhalala, U, Haghighi, M, Norton, K. Computed tomography scan measurement of abdominal wall thickness for application of near-infrared spectroscopy probes to monitor regional oxygen saturation index of gastrointestinal and renal circulations in children. Pediatr Crit Care Med 2011; 12: e145–e148.CrossRefGoogle ScholarPubMed