Volume 14, Issue 12 pp. 989-995

Tissue oxygenation monitoring during major pediatric surgery using transcutaneous liver near infrared spectroscopy

MARKUS WEISS

MARKUS WEISS

Department of Anaesthesia, University Children's Hospital

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GABRIELE SCHULZ

GABRIELE SCHULZ

Department of Neonatology, University Hospital

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IAN TELLER

IAN TELLER

Department of Intensive Care and Neonatology, University Children's Hospital

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ALEXANDER DULLENKOPF

ALEXANDER DULLENKOPF

Department of Anaesthesia, University Children's Hospital

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ANNA KOLAROVA

ANNA KOLAROVA

Department of Intensive Care and Neonatology, University Children's Hospital

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HERRMANN SAILER

HERRMANN SAILER

Department of Craniofacial Surgery, University Hospital, Zurich, Switzerland

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CLAUDIA M. DILLIER

CLAUDIA M. DILLIER

Department of Anaesthesia, University Children's Hospital

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HANS U. BUCHER

HANS U. BUCHER

Department of Neonatology, University Hospital

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ANDREAS C. GERBER

ANDREAS C. GERBER

Department of Anaesthesia, University Children's Hospital

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OSKAR BAENZIGER

OSKAR BAENZIGER

Department of Intensive Care and Neonatology, University Children's Hospital

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First published: 09 December 2004
Citations: 15
Markus Weiss, Department of Anaesthesia, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland (email: [email protected]).

Abstract

Background : The aim of the study was to compare liver tissue oxygenation determined by near infrared spectroscopy (NIRS) with central venous oxygen saturation (SvO2) and intestinal perfusion as measured by gastric intramucosal pH (pHi) in pediatric surgical patients.

Methods : Twenty children undergoing craniofacial surgery with expected major intraoperative blood loss were studied. NIRS tissue oxygenation index (TOILiver) and pHi values were recorded. Arterial blood gas analysis and SvO2 were assessed from periodically taken blood samples. Data are presented as ranges (median) and were compared using linear regression analysis. Sensitivity and specificity of the intra-individual changes in TOILiver to predict falling SvO2 or pHi values were calculated.

Results : Patients age ranged from 0.79 to 8.27 years (1.92 years). TOILiver ranged from 41.5 to 77.4% (61.5%), gastric pHi from 7.13 to 7.60 (7.37) and SvO2 from 51 to 86% (74%). Among patients only moderate correlation was found between TOILiver and SvO2 (r = 0.594, P < 0.0001) and gastric pHi (r = 0.502, P < 0.0001). Intra-individual measured TOILiver values, however, demonstrated close correlation with SvO2 values (r = 0.680 to 0.976) but a varying correlation with gastric pHi values (r = 0.055 to 0.972). Sensitivity/specificity of TOILiver to predict decreasing SvO2 or gastric pHi values were 76.4/73.4% and 67.4/62.7% respectively.

Conclusions : TOILiver provided a better trend monitor of central venous oxygen saturation than gastric intramucosal pH. Because of its limited sensitivity and specificity to indicate deterioration of SvO2, liver tissue oxygenation measured by transcutaneous NIRS does not provide additional practical information for clinical management.

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