Agreement of somatic and renal near-infrared spectroscopy with reference blood samples during a controlled hypoxia sequence: a healthy volunteer study.

PURPOSE: O3® Regional Oximetry (Masimo Corporation, California, USA) is validated for cerebral oximetry. We aimed to assess agreement of somatic and renal near-infrared spectroscopy with reference blood samples. METHODS: O3 sensors were placed bilaterally on the quadriceps and flank of 26 healthy volunteers. A stepped, controlled hypoxia sequence was performed by adding a mixture of nitrogen and room air to the breathing circuit. O3-derived oxygen saturation values were obtained at baseline and at six decremental saturation levels (5% steps). Blood samples (radial artery, iliac vein (somatic reference) and renal vein) were obtained at each step. Reference values were calculated as: 0.7 × venous saturation + 0.3 × arterial saturation. The agreement between O3-derived values with blood reference values was assessed by calculating root-mean-square error accuracy and Bland-Altman plots. RESULTS: The root-mean-square error accuracy was 6.0% between quadriceps oxygen saturation and somatic reference values. The mean bias was 0.8%, with limits of agreement from -7.7 to 9.3%. These were 5.1% and 0.6% (-8.3 to 9.5%) for flank oxygen saturation and somatic reference values, respectively, and 7.7% and -4.9% (-15.0 to 5.2%) for flank oxygen saturation and renal reference values. The kidney depth was 3.1 ± 0.9 cm below the skin. CONCLUSION: O3 regional oximetry can be used on the quadriceps and flank to monitor somatic saturation, yet has a saturation-level dependent bias. O3-derived values obtained at the flank underestimated renal reference values. Additionally, it is unlikely that the flank sensors did directly measure renal tissue. TRIAL REGISTRATION: Clinicaltrials.gov (NCT04584788): registered October 6th, 2020.

Cerebral oxygenation during pediatric congenital cardiac surgery and its association with outcome: a retrospective observational study.

PURPOSE: Non-invasive cerebral oxygen saturation (ScO2) monitoring is an established tool in the intraoperative phase of pediatric congenital cardiac surgery (CCS). This study investigated the association between ScO2 and postoperative outcome by investigating both baseline ScO2 values and intraoperative desaturations from baseline. METHODS: All CCS procedures performed in the period 2010-2017 in our institution in which ScO2 was monitored were included in this historical cohort study. Baseline ScO2 was determined after tracheal intubation, before surgical incision. Subgroups were based on cardiac pathology and degree of intracardiac shunting. Poor outcome was defined based on length of stay (LOS) in the intensive care unit (ICU)/hospital, duration of mechanical ventilation (MV), and 30-day mortality. Intraoperatively, ScO2 total time below baseline (TBBL) and ScO2 time-weighted average (TWA) were calculated. RESULTS: Data from 565 patients were analyzed. Baseline ScO2 was significantly associated with LOS in ICU (odds ratio [OR] per percentage decrease in baseline ScO2, 0.95; 95% confidence interval [CI], 0.93 to 0.97; P < 0.001), with LOS in hospital (OR, 0.93; 95% CI, 0.91 to 0.96; P < 0.001), with MV duration (OR, 0.92; 95% CI, 0.90 to 0.95; P < 0.001) and with 30-day mortality (OR, 0.94; 95% CI, 0.91 to 0.98; P = 0.007). Cerebral oxygen saturation TWA had no associations, while ScO2 TBBL had only a small association with LOS in ICU (OR, 1.02; 95% CI, 1.01 to 1.03; P < 0.001), MV duration (OR,1.02; 95% CI, 1.01 to 1.03; P = 0.002), and LOS in hospital (OR, 1.02; 95% CI, 1.01 to 1.04; P < 0.001). CONCLUSION: In pediatric patients undergoing cardiac surgery, low baseline ScO2 values measured after tracheal intubation were associated with several adverse postoperative outcomes. In contrast, the severity of actual intraoperative cerebral desaturation was not associated with postoperative outcomes. Baseline ScO2 measured after tracheal intubation may help identify patients at increased perioperative risk.

RéSUMé: OBJECTIF: Le monitorage non invasif de la saturation cérébrale en oxygène (ScO2) est un outil bien établi en phase peropératoire de chirurgie cardiaque congénitale pédiatrique. Cette étude a examiné l'association entre la ScO2 et le pronostic postopératoire en étudiant les valeurs de ScO2 initiales et les désaturations peropératoires par rapport à ces valeurs. MéTHODE: Toutes les interventions en chirurgie cardiaque congénitale réalisées entre 2010 et 2017 dans notre établissement et au cours desquelles la ScO2 a été monitorée ont été incluses dans cette étude de cohorte historique. La ScO2 de base était déterminée après l'intubation trachéale, avant l'incision chirurgicale. Les sous-groupes ont été catégorisés en fonction de la pathologie cardiaque et des shunts intracardiaques. Un mauvais pronostic était défini en fonction de la durée de séjour à l'unité de soins intensifs (USI)/ l'hôpital, de la durée de ventilation mécanique et de la mortalité à 30 jours. Pendant l'intervention, le temps total pendant lequel la ScO2 était au-dessous des valeurs de base et la moyenne pondérée dans le temps ont été calculés. RéSULTATS: Les données de 565 patients ont été analysées. Une association significative a été observée entre la ScO2 de base et la durée de séjour à l'USI (diminution du rapport de cotes [RC] par pourcentage de la ScO2 de base, 0,95; intervalle de confiance [IC] 95 %, 0,93 à 0,97; P < 0,001), la durée de séjour à l'hôpital (RC, 0,93; IC 95 %, 0,91 à 0,96; P < 0,001), la durée de ventilation mécanique (RC, 0,92; IC 95 %, 0,90 à 0,95; P < 0,001) et la mortalité à 30 jours (RC, 0,94; IC 95 %, 0,91 à 0,98; P = 0,007). La moyenne pondérée dans le temps de la saturation cérébrale en oxygène n'a pas révélé d'association, alors que le temps total au-dessous des valeurs de base de ScO2 n'a révélé qu'une petite association avec la durée de séjour à l'USI (RC, 1,02; IC 95 %, 1,01 à 1,03; P < 0,001), la durée de ventilation mécanique (RC, 1,02; IC 95 %, 1,01 à 1,03; P = 0,002), et la durée de séjour à l'hôpital (RC, 1,02; IC 95 %, 1,01 à 1,04; P < 0,001). CONCLUSION: Chez les patients pédiatriques subissant une chirurgie cardiaque, des valeurs de ScO2 basses lorsque mesurées après l'intubation trachéale étaient associées à plusieurs complications postopératoires. En revanche, la gravité de la désaturation cérébrale peropératoire n'était pas associée aux devenirs postopératoires. La ScO2 de base mesurée après l'intubation trachéale pourrait nous aider à identifier les patients courant un risque périopératoire accru.

Pain, impaired functioning, poor satisfaction and diminished health status eight years following perilunate (fracture) dislocations.

Purpose: Perilunate (fracture) dislocations are rare injuries and diminished functional outcomes are reported. However, Patient Reported Outcomes (PROs) following these injuries are rarely described. The aim of this study was to investigate the long-term impact of perilunate (fracture) dislocations using a range of measures, including pain, function, and quality of life.Materials and Methods: This cross-sectional study was conducted from January 2016 until March 2016. Eleven patients who had suffered from perilunate (fracture) dislocations between August 1996 and January 2014 were matched on age and gender with 22 healthy controls. Functional outcome included range of motion and grip strength measurements. The Patient Reported Outcomes included: Patient Reported Wrist Evaluation, Disability of Arm, Shoulder and Hand questionnaire, Michigan Hand Questionnaire and the Short Form-36.Results: The 11 patients that were included (9 males) had a median age at injury of 38 years (IQR 33; 54) and median follow up of 97 months (IQR 84-193). Flexion/extension (mean difference -60°, 95% CI -76, -43, p < 0.001) and ulnar/radial deviation (mean difference -28°, 95% CI -38, -18, p < 0.001) were significantly diminished in patients following perilunate (fracture) dislocations. Grip strength was not affected. The patients experienced significantly more pain as assessed on all pain subscales. Physical functioning was significantly worse in the group with perilunate (fracture) dislocations as assessed on all function subscales, except the PRWE function score and the subscale physical functioning of the Short Form-36. Satisfaction as measured with the Michigan Hand Questionnaire satisfaction subscale (mean difference -36, 95% CI -57, -16, p = 0.002) was also reported poorer. No difference was found regarding work participation.Conclusions: A perilunate (fracture) dislocation has a significant impact on everyday life, as patients experience diminished range of motion, pain, diminished physical functioning, diminished satisfaction and report lower general health status than healthy controls. However, no consequences for work participation were found in this study. Level of evidence 3.Implications for rehabilitationFlexion/extension and ulnar/radial deviation remains limited following perilunate (fracture) dislocations.Grip strength is not diminished in patients with perilunate (fracture) dislocations.Pain, restrictions in physical functioning, diminished satisfaction and lower general health status are likely to be present following perilunate (fracture) dislocations.If conservative treatment including pain medication and rehabilitation strategies do not relief pain following perilunate (fracture) dislocations, surgical treatment options such as wrist denervation or arthrodesis should be considered.