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Wang B, Shi H, Yao Y, Liu S, Shi C. The Association Between Renal Desaturation Measured Using Near-Infrared Spectroscopy and Postoperative Acute Kidney Injury: A Systematic Review. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00522-6. [PMID: 39218761 DOI: 10.1053/j.jvca.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/22/2024] [Accepted: 08/04/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES The objective of this systematic review was to clarify the status of near-infrared spectroscopy (NIRS) in monitoring perioperative renal regional tissue oxygen saturation (rSO2) and determine whether there is evidence supporting its use in predicting postoperative acute kidney injury (AKI). DESIGN A systematic search of electronic databases was conducted to identify all clinical studies that utilized NIRS to monitor renal rSO2 during the perioperative period to observe postoperative AKI. SETTING Studies published online as of May 31, 2024, were included in the review. PARTICIPANTS Studies involving human participants undergoing surgery with a predefined outcome of AKI were included. INTERVENTIONS Regional tissue oxygen saturation was measured using NIRS. MEASUREMENTS AND MAIN RESULTS A total of 144 records were identified in the primary search after removing duplicates. After screening, 18 studies were included in the analysis, consisting of 3 case-control studies and 15 prospective cohort studies. Thirteen reports focused on pediatric surgery, whereas five reports focused on adult surgery. Sixteen studies involved cardiovascular surgery with cardiopulmonary bypass, and two studies focused on liver surgery. All studies received a quality score of 7 or above. Significant heterogeneity and mostly short follow up periods were noted. CONCLUSION Renal desaturation may indicate AKI in patients; however, further studies are required to substantiate this relationship. Additional clinical trials are necessary to evaluate normal values and establish the exact threshold of renal rSO2 that signifies a meaningful decline in renal function.
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Affiliation(s)
- Bo Wang
- Department of Anesthesiology, Peking University International Hospital, Beijing, China
| | - Hui Shi
- Department of Anesthesiology, Shijingshan Hospital, Beijing, China
| | - Yuntai Yao
- Department of Anesthesiology, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Fuwai Hospital, Peking Union Medical College, Beijing, China
| | - Shen Liu
- Department of Cardiac Surgery, Peking University International Hospital, Beijing, China
| | - Chunxia Shi
- Department of Anesthesiology, Peking University International Hospital, Beijing, China.
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Kooi EMW, Mintzer JP, Rhee CJ, Ergenekon E, Schwarz CE, Pichler G, de Boode WP. Neonatal somatic oxygenation and perfusion assessment using near-infrared spectroscopy : Part of the series on near-infrared spectroscopy by the European Society of Paediatric Research Special Interest Group "Near-Infrared Spectroscopy". Pediatr Res 2024:10.1038/s41390-024-03226-z. [PMID: 38730022 DOI: 10.1038/s41390-024-03226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/27/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024]
Abstract
In this narrative review, we summarize the current knowledge and applications of somatic near-infrared spectroscopy (NIRS), with a focus on intestinal, renal, limb, and multi-site applications in neonates. Assessing somatic oxygenation at various body locations in neonates may aid in the understanding of underlying pathophysiology of organ injury. Considering cerebral autoregulation may be active to protect the brain during systemic circulatory failure, peripheral somatic oxygenation may potentially provide an early indication of neonatal cardiovascular failure and ultimate hypoxemic injury to vital organs including the brain. Certain intestinal oxygenation patterns appear to be associated with the onset and course of necrotizing enterocolitis, whereas impaired renal oxygenation may indicate the onset of acute kidney injury after various types of hypoxic events. Peripheral muscle oxygenation measured at a limb may be particularly effective in the early prediction of shock in neonates. Using multi-site NIRS may complement current approaches and clinical investigations to alert for neonatal tissue hypoxemia, and potentially even guide management. However, somatic NIRS has its inherent limitations in regard to accuracy. Interpretation of organ-specific values can also be challenging. Last, currently there are limited prospective intervention studies, and clinical benefits need to be examined further, after the clarification of critical threshold-values. IMPACT: The assessment of somatic oxygenation using NIRS may contribute to the prediction of specific diseases in hemodynamically challenged neonates. Furthermore, it may give early warning signs for impending cardiovascular failure, and impaired cerebral circulation and oxygenation. We present a comprehensive overview of the literature on applications of NIRS to various somatic areas, with a focus on its potential clinical applicability, including future research directions. This paper will enable prospective standardized studies, and multicenter collaboration to obtain statistical power, likely to advance the field.
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Affiliation(s)
- Elisabeth M W Kooi
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Jonathan P Mintzer
- Division of Newborn Medicine, Department of Pediatrics, Mountainside Medical Center, Montclair, NJ, USA
| | | | | | - Christoph E Schwarz
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
- Department of Neonatology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gerhard Pichler
- Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
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Abstract
BACKGROUND Acute kidney injury (AKI) affects approximately 30% of infants admitted to the neonatal intensive care unit (NICU), and increases mortality risk by 50%. Current diagnostic criteria (serum creatinine rise with oliguria) cannot detect early-onset AKI, as up to 50% of nephron damage may occur by the time these abnormalities present. Once AKI is established, clinical management is often ineffective; therefore, prevention is key. Near-infrared spectroscopy (NIRS) offers a feasible, noninvasive approach to continuously monitor renal oxygenation trends over time, serving as a surrogate marker for renal perfusion. PURPOSE To provide an overview of NIRS principles for measuring renal oxygenation, and to describe current evidence of how this technology is being used among infants admitted to the NICU relative to the prediction and identification of AKI. METHODS A comprehensive search of PubMed and CINHAL focused on renal NIRS studies in NICU preterm and term infants was conducted. RESULTS Findings from 34 studies were included. In term infants, reduced renal oxygenation correlated to invasive SvO2 monitoring, predicted survivability and AKI. In preterm infants, reduced renal oxygenation was associated with AKI in one study, yet contrasting findings were reported in those with patent ductus arteriosus, including those who received prostaglandin inhibitors. Normative data in all infants were sparse. IMPLICATIONS FOR PRACTICE Renal NIRS may offer a noninvasive measurement of kidney hypoperfusion that may precede conventional diagnostic measures. IMPLICATIONS FOR RESEARCH Normative data are lacking, the threshold for renal ischemia is not defined, and consensus guiding clinical treatment based on NIRS data is nonexistent.
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Sinner B, Banas M, Brunete-Lorenzo C, Zant R, Knoppke B, Scherer MN, Graf BM, Lunz D. Acute Kidney Injury and Renal Regional Oxygen Saturation During Pediatric Liver Transplantation. Ann Transplant 2020; 25:e919717. [PMID: 31988274 PMCID: PMC7006365 DOI: 10.12659/aot.919717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Kidney injury is a complication among children undergoing liver transplantation (pLTx). Cystatin C serum concentration seems to be superior to creatinine-based determination of kidney injury in adults and children. Near-infrared spectroscopy (NIRS) technology provides non-invasive and real-time measurement of renal tissue oxygenation. Here, we compared renal tissue oximetry (rSrO2) with conventional diagnostic criteria cystatin C and creatinine concentration in children undergoing pLTx. Material/Methods rSrO2 was measured intraoperatively in children undergoing pLTx over the left kidney, and was statistically compared with pre- and postoperative serum creatinine and cystatin C concentrations. Results rSrO2 was affected by hemoglobin concentration, bilirubin concentration, and FiO2. Statistical analysis demonstrated that rSrO2 was significantly reduced in children with preoperative pathologic increased cystatin C concentrations compared to children without (63.7±4.3 vs. 53.4±4.9, p<0.05). We did not detect a significant difference in rSrO2 between children who developed postoperative renal impairment, either determined by increased postoperative cystatin C concentration, creatinine concentration, or the pRIFLE criteria. Intraoperative increase or decrease in rSrO2 did not predict the development of postoperative kidney injury. Conclusions In children with liver failure undergoing pLTx, a preoperative decrease in rSrO2 indicates compromised renal function. However, intraoperative rSrO2 is not predictive of postoperative kidney injury.
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Affiliation(s)
- Barbara Sinner
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Miriam Banas
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | | | - Robert Zant
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Birgit Knoppke
- KUNO University Children's Hospital, Regensburg, Germany
| | - Marcus N Scherer
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard M Graf
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
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Kreuzer M, Sames-Dolzer E, Schausberger L, Tulzer A, Ratschiller T, Haizinger B, Tulzer G, Mair R. Double-arterial cannulation: a strategy for whole body perfusion during aortic arch reconstruction. Interact Cardiovasc Thorac Surg 2019; 27:742-748. [PMID: 29722889 DOI: 10.1093/icvts/ivy147] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/27/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Double-arterial cannulation enables cerebral perfusion and lower body perfusion during aortic arch reconstruction. The aim of this study was to analyse and report our experience of using this cannulation and perfusion technique on paediatric patients. METHODS A retrospective single-centre study was carried out on 407 consecutive paediatric patients who underwent an aortic arch reconstruction under double-arterial cannulation between 2003 and 2015. The median age of the patients at surgery was 8 (range 2-5570) days, and body weight was 3.3 (range 1.8-60) kg. All operations were performed through standard median sternotomy. One arterial cannula was inserted into the innominate artery and the second one into the supradiaphragmatic descending aorta. Primary end points were 30-day mortality, acute renal failure requiring dialysis and time until lactate level decreased to ≤2 mmol/l postoperatively. RESULTS We found an in-hospital mortality of 8.6%. Lethal incident was not associated with the cannulation method, and 1 intraoperative lesion of the descending aorta could be repaired immediately. The median lactate level of the patients on arrival at the intensive care unit was 3.5 mmol/l [quartile (Q)1: 2.3-Q3: 4.7] and creatinine was 0.48 mg/100 ml (Q1: 0.40-Q3: 0.58). The longest duration until the lactate level decreased to ≤ 2 mmol/l was found in the group of 264 univentricular patients (median 11 h, Q1: 6-Q3: 24). Seven (1.7%) patients of the whole cohort required peritoneal dialysis postoperatively. CONCLUSIONS Double-arterial cannulation is a simple and safe method for perfusing the brain and the lower parts of the body during aortic arch reconstruction. Perioperative survival and freedom from procedure-related complications in this demanding patient population are encouraging.
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Affiliation(s)
- Michaela Kreuzer
- Division of Paediatric Cardiac Surgery, Children's Heart Centre Linz, Linz, Austria
| | - Eva Sames-Dolzer
- Division of Paediatric Cardiac Surgery, Children's Heart Centre Linz, Linz, Austria
| | - Laura Schausberger
- Division of Paediatric Cardiac Surgery, Children's Heart Centre Linz, Linz, Austria
| | - Andreas Tulzer
- Division of Paediatric Cardiology, Children's Heart Centre Linz, Linz, Austria
| | - Thomas Ratschiller
- Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
| | - Bettina Haizinger
- Clinic of Anesthesiology and Intensive Care, Kepler University Hospital, Linz, Austria
| | - Gerald Tulzer
- Division of Paediatric Cardiology, Children's Heart Centre Linz, Linz, Austria
| | - Rudolf Mair
- Division of Paediatric Cardiac Surgery, Children's Heart Centre Linz, Linz, Austria
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Leow EH, Chan YH, Ng YH, Lim JKB, Nakao M, Lee JH. Prevention of Acute Kidney Injury in Children Undergoing Cardiac Surgery: A Narrative Review. World J Pediatr Congenit Heart Surg 2018; 9:79-90. [PMID: 29310552 DOI: 10.1177/2150135117743211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Children undergoing cardiac surgery are at risk of developing acute kidney injury (AKI). Preventing cardiac surgery-associated AKI (CS-AKI) is important as it is associated with increased early- and long-term mortality and morbidity. Targeting modifiable risk factors (eg, avoiding poor renal perfusion, nephrotoxic drugs, and fluid overload) reduces the risk of CS-AKI. There is currently no strong evidence for the routine use of pharmacological approaches (eg, aminophylline, dexmedetomidine, fenoldopam, and steroids) to prevent CS-AKI. There is robust evidence to support the role of early peritoneal dialysis as a nonpharmacologic approach to prevent CS-AKI.
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Affiliation(s)
- Esther Huimin Leow
- 1 Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yoke Hwee Chan
- 2 Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore.,3 Duke-NUS School of Medicine, Singapore, Singapore
| | - Yong Hong Ng
- 1 Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Joel Kian Boon Lim
- 1 Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Masakazu Nakao
- 4 Department of Paediatric Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jan Hau Lee
- 2 Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore.,3 Duke-NUS School of Medicine, Singapore, Singapore
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Ricci Z, Haiberger R, Tofani L, Romagnoli S, Favia I, Cogo P. Multisite Near Infrared Spectroscopy During Cardiopulmonary Bypass in Pediatric Patients. Artif Organs 2015; 39:584-90. [DOI: 10.1111/aor.12424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Zaccaria Ricci
- Department of Cardiology and Cardiac Surgery; Pediatric Cardiac Intensive Care Unit; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Roberta Haiberger
- Department of Cardiology and Cardiac Surgery; Pediatric Cardiac Intensive Care Unit; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Lorenzo Tofani
- Department of Neurosciences, Psychology, Drug Research and Child Health; University of Florence; Florence Italy
| | - Stefano Romagnoli
- Department of Human Health Sciences; Section of Anaesthesiology and Intensive Care; University of Florence; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Isabella Favia
- Department of Cardiology and Cardiac Surgery; Pediatric Cardiac Intensive Care Unit; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Paola Cogo
- Department of Cardiology and Cardiac Surgery; Pediatric Cardiac Intensive Care Unit; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
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