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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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