Dilek ALTUN, Abdullah DOĞAN, Ahmet ARNAZ, Adnan YÜKSEK, Yusuf Kenen YALÇINBAŞ, Rıza TÜRKÖZ, Tayyar SARIOĞLU

Noninvasive monitoring of central venous oxygen saturation by jugular transcutaneous near-infrared spectroscopy in pediatric patients undergoing congenital cardiac surgery

Background and aim: In patients undergoing congenital cardiac surgery, it is crucial to maintain oxygen demand-consumption balance. Central venous oxygen saturation $(ScvO_2)$ is a useful indicator of oxygen demand and consumption balance which is an invasive method. Near-infrared spectroscopy (NIRS) is a noninvasive, continuous monitoring technique that measures regional tissue oxygenation. NIRS that is placed over the internal jugular vein cutaneous area (NIRSijv) has the potential to show $ScvO_2$ indirectly. In this study, we aimed to determine the correlation between $ScvO_2$with NIRSijv in pediatric patients undergoing congenital cardiac surgery. Materials and methods: Fifty children participated in the study. Four patients were excluded for the inability of internal jugular vein (IJV) catheterization due to technical difficulties. After anesthesia induction, NIRS probes were placed on the IJV site with ultrasound guidance for the measurement of continuous transcutaneous oxygen saturation. The catheter insertion was also done through the IJV from the other side using ultrasound guidance. Cerebral oxygenation monitoring was done using NIRS with a single pediatric probe placed on the right forehead. Values of NIRSijv, cerebral NIRS (NIRSc) and $ScvO_2$ , were recorded at certain times until postoperative 24th hour. Results: Data were collected at 8 different time points. There was a significant correlation between $ScvO_2$ and NIRSijv in all measurement time points (r = 0.91), (P = 0.001). The mean bias between $ScvO_2$ and NIRSijv was 2.92% and the limits of agreement were from 11% to –5.2%. There was a moderate correlation between$ScvO_2$ and NIRSc (r = 0.45), (P = 0.001). The mean bias between $ScvO_2$ and NIRSc was 2.7% and the limits of agreement were from +26% to –20%. Conclusion: In this study, we found a strong correlation between $ScvO_2$and NIRS measurements taken from the internal jugular vein site. Accordingly, continuous noninvasive monitoring with transcutaneous NIRSijv can be an alternative method as a trend monitor for the central venous oxygen saturation in pediatric cardiac patients undergoing congenital cardiac surgery

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