Abstract
In neonates and children undergoing cardiac surgery, assessment of the microcirculation is increasingly recognized as being important for optimal care. Conventional hemodynamic monitoring techniques do not allow assessment of the microcirculation. Assessment of the renal microcirculation is further complicated due to its dependency on the macrocirculation, organ-specific autoregulatory mechanisms, and interactions with other organs. NIRS (near-infrared spectroscopy) is noninvasive technology increasingly used in the operative and critical care environments to assess regional oxygen supply-demand balance. The NIRS oximeter measures regional changes in oxygenated and deoxygenated hemoglobin in the tissue under the probe which emits two different wavelengths of near-infrared light (730 and 810 nm), corresponding to the different spectral absorptions of oxygenated and deoxygenated hemoglobin. Measuring the quantity of returning light of each wavelength allows for the assessment of changes in the concentration of these molecules and the measured value represents the oxygen content in the local tissue bed. NIRS has been studied extensively in animals, including models of renal ischemia and reperfusion, and is widely used for monitoring brain oxygenation in neonates. More recently, it is being used to continuously visualize, by a probe placed on the flank, renal microcirculation disturbance in neonates and young children, particularly in pediatric cardiac intensive care units and during cardiac surgery.
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References
Ortmann L, Fontenot E, Seib P, et al. Use of near-infrared spectroscopy for estimation of renal oxygenation in children with heart disease. Pediatr Cardiol. 2011;32:748–53.
Booth E, Dukatz C, Ausman J, et al. Cerebral and somatic venous oximetry in adults and infants. Surg Neurol Int. 2010;1(75)
McNeill S, Gatenby J, McElroy S, et al. Normal cerebral, renal and abdominal regional oxygen saturations using near-infrared spectroscopy in preterm infants. J Perinatol. 2010;3:51–7.
Joffe R, Al Aklabi M, Bhattacharya S, et al. Cardiac surgery–associated kidney injury in children and renal oximetry. Pediatr Crit Care Med. 2018;19:839–45.
Adams P, Vargas D, Baust T, et al. Associations of perioperative renal oximetry via near-infrared spectroscopy, urinary biomarkers, and postoperative acute kidney injury in infants after congenital heart surgery: should creatinine continue to be the gold standard? Pediatr Crit Care Med. 2019;20:27–37.
Algra S, Schouten A, van Oeveren W, et al. Low-flow antegrade cerebral perfusion attenuates early renal and intestinal injury during neonatal aortic arch reconstruction. J Thorac Cardiovasc Surg. 2012;144:1323–8.
Hoffman G, Stuth E, Jaquiss R, et al. Changes in cerebral and somatic oxygenation during stage 1 palliation of hypoplastic left heart syndrome using continuous regional cerebral perfusion. J Thorac Cardiovasc Surg. 2004;127:223–33.
Li J, Van Arsdell G, Zhang G, et al. Assessment of the relationship between cerebral and splanchnic oxygen saturations measured by near-infrared spectroscopy and direct measurements of systemic haemodynamic variables and oxygen transport after the Norwood procedure. Heart. 2006;92:1678–85.
Lau P, Cruz S, Garcia-Prats J, et al. Use of renal near-infrared spectroscopy measurements in congenital diaphragmatic hernia patients on ECMO. J Pediatr Surg. 2017;2017(52):689–92.
Petrova A, Mehta R. Near-infrared spectroscopy in the detection of regional tissue oxygenation during hypoxic events in preterm infants undergoing critical care. Pediatr Crit Care Med. 2006;7:449–54.
Petrova A, Mehta R. Regional tissue oxygenation in association with duration of hypoxaemia and haemodynamic variability in preterm neonates. Arch Dis Child Fetal Neonatal Ed. 2010;95:F213–9.
van der Laan M, Roofthooft M, Fries M, et al. A hemodynamically significant patent ductus arteriosus does not affect cerebral or renal tissue oxygenation in preterm infants. Neonatology. 2016;110:141–7.
Westgarth-Taylor C, de Lijster L, van Bogerijen G, et al. A prospective assessment of renal oxygenation in children undergoing laparoscopy using near-infrared spectroscopy. Surg Endosc. 2013;27:3696.
Chock V, Frymoyer A, Yeh C, et al. Renal saturation and acute kidney injury in neonates with hypoxic ischemic encephalopathy undergoing therapeutic hypothermia. J Pediatr. 2018;200:232–9.
Hazle M, Gajarski R, Aiyagari R, et al. Urinary biomarkers and renal near-infrared spectroscopy predict intensive care unit outcomes after cardiac surgery in infants younger than 6 months of age. J Thorac Cardiovasc Surg. 2013;146:861–7.
Owens G, King K, Gurney J, et al. Low renal oximetry correlates with acute kidney injury after infant cardiac surgery. Pediatr Cardiol. 2011;32:183–8.
Ruf B, Bonelli V, Balling G, et al. Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case-control study. Crit Care. 2015;19(27)
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Morgan, C.J. (2021). Renal Oximetry in Neonates and Children During Cardiac Surgery. In: Sethi, S.K., Raina, R., McCulloch, M., Bunchman, T.E. (eds) Advances in Critical Care Pediatric Nephrology. Springer, Singapore. https://doi.org/10.1007/978-981-33-4554-6_11
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DOI: https://doi.org/10.1007/978-981-33-4554-6_11
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