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Age Difference of the Relationship Between Cerebral Oxygen Saturation and Physiological Parameters in Pediatric Cardiac Surgery with Cardiopulmonary Bypass: Analysis Using the Random-Effects Model

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Abstract

Recently, monitoring of cerebral oxygen saturation (ScO2) has become widespread in pediatric cardiac surgery. Our previous study reported that mean blood pressure (mBP) was the major contributor to ScO2 throughout cardiac surgery with cardiopulmonary bypass (CPB) in children weighing under 10 kg. We speculated that this result might be attributable to incomplete cerebral autoregulation in such young children. Accordingly, our hypothesis is that the relationship between ScO2 and the physiological parameters may change according to the growth of the children. ScO2 was measured with an INVOS 5100C (Somanetics, Troy, MI). Random-effects analysis was employed with ScO2 as a dependent variable, and seven physiological parameters (mBP, central venous pressure, nasopharyngeal temperature, SaO2, hematocrit, PaCO2, and pH) were entered as independent covariates. The analysis was performed during the pre-CPB, CPB, and post-CPB periods by dividing the patients into two groups: infants (Infant Group) and children who were more than 1 year old (Child Group). The Infant and Child Groups consisted of 28 and 21 patients. In the random-effects analysis, mBP was the major contributor to ScO2 during CPB in both groups. During the pre-CPB period, the effect of mBP was strongest in the Infant group. However, its effect was second to that of SaO2 in the Child Group. During the post-CPB period, SaO2 and mBP still affected ScO2 in the Infant group. However, the dominant contributors were unclear in the Child Group. Cerebral autoregulation may be immature in infants. In addition, it may be impaired during CPB even after 1 year of age.

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Acknowledgements

The authors are deeply grateful to the staff members of the Department of Cardiovascular and Thoracic Surgery of Hokkaido University Hospital for their generous support.

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Authors and Affiliations

  1. Department of Anesthesiology, Hokkaido University Hospital, N14 W5, Sapporo, 0608648, Japan

    Masataka Yamamoto, Takayuki Toki, Yasunori Kubo, Koji Hoshino & Yuji Morimoto

  2. Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Sapporo, 0608638, Japan

    Masataka Yamamoto & Yuji Morimoto

Authors
  1. Masataka Yamamoto
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  2. Takayuki Toki
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  3. Yasunori Kubo
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  4. Koji Hoshino
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  5. Yuji Morimoto
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Contributions

Conceptualization: [MY, YM], Methodology: [MY, YM], Formal analysis and investigation: [TT, YK, MY], Writing—original draft preparation: [MY, YM]; Writing—review and editing: [KH].

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Correspondence to Yuji Morimoto.

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Conflict of interest

The authors did not receive support from any organization for the submitted work. The authors have no relevant financial or non-financial interests to disclose.

Research Involving Human Rights

This is an observational prospective study. This was approved by Institutional Review Board of the Hokkaido University Hospital (IRB #016-0505). The trial was registered at UMIN Clinical Trials Registry prior patient enrollment (UMIN000028597).

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Written informed consent was obtained from the parents of all subjects participating in the trial.

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Yamamoto, M., Toki, T., Kubo, Y. et al. Age Difference of the Relationship Between Cerebral Oxygen Saturation and Physiological Parameters in Pediatric Cardiac Surgery with Cardiopulmonary Bypass: Analysis Using the Random-Effects Model. Pediatr Cardiol 43, 1606–1614 (2022). https://doi.org/10.1007/s00246-022-02889-x

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  • DOI: https://doi.org/10.1007/s00246-022-02889-x

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