Supervisors info:
Ιακωβίδου Νικολέττα, Αναπληρώτρια Καθηγήτρια Παιδιατρικής-Νεογνολογίας, Ιατρική, ΕΚΠΑ
Ξάνθος Θεόδωρος, Καθηγηγτής Ιατρικής, Ιατρική, ΕΚΠΑ
Στάικου Χρυσούλα, Αναπληρώτρια Καθηγήτρια Αναισθησιολογίας, Ιατρική, ΕΚΠΑ
Summary:
Objective: Advances in paediatric cardiac surgery, correction of complex congenital heart disease and the increased survival rate of the patients are great steps that have been done in the recent years. Since congenital heart surgery has been associated with neurological complications and neurodevelopmental problems prevention of major shifts in oxygenation might have a positive effect on clinical outcome related to central nervous system. Recognition of those patients who are at risk for developing neurologic complications (early or late) after cardiac surgery with cardiopulmonary bypass is very important.
In this study we investigate the correlation between cerebral rSO2 and lactate, which are two factors that are affected by oxygenation, as well as any interaction of both of them with hemoglobulin, PaCO2 and mean blood pressure (MBP).
Methods: Between November and May 2016, 18 paediatric patients who underwent congenital heart surgery were enrolled into the study. Ages ranged from 6 months to 5,5 years. NIRS sensor was placed on the right and left forehead of the patients and measurement time was divided into 11 stages: t1-before induction of anaesthesia, t2-before sternotomy, t3-after sternotomy, t4-before aortic cannulation, t5-after aortic cannulation, t6-beginning of CPB, t7-before aortic clamping, t8- after aortic clamping, t9-cooling, t10-rewarming, t11-CPB off. Data collection of lactate, Hb, PaCO2 and MBP included measurements of each parameter at all 11 stages.
Results: rSO2 showed a significant decrease until t8, while after t8 a significant increase was found. Lactate showed a significant increase until t8, while after t8 a significant decrease was found. Analysis revealed the same trend for MAP and Hb. PaCO2 was not significantly changed until t8, but afterwards a significant increase was observed. Also, analysis revealed a significant and negative correlation of rSO2 with lactate during the follow up. PaCO2 and Hb were positively associated with rSO2. Additional analysis showed that lactate was negatively correlated with PaCO2 (β=-0.04, SE=0.01, P=0.005) and Hb (β=-0.14, SE=0.06, P=0.016).
Conclusion: Cerebral protection during CPB is critical in congenital heart surgery. Measurements of rSO2 values and lactate levels seem to have a strong inverse correlation. Interpretation of these recordings lead to early intervention and modification of parameters which are also important to tissue oxygenation.
Further evaluations will be necessary to reveal the interaction between lactate, NIRS and other parameters that affect perfusion and oxygenation.
