Near-Infrared Spectroscopy for Off-Pump Pediatric Cardiac Surgery

Abstract

Objective: Near-infrared spectroscopy (NIRS) is a noninvasive monitoring tool used to assess tissue oxygenation in a wide spectrum of clinical scenarios. This study evaluates its use in identifying cerebral and somatic flow alteration during off-pump pediatric cardiac surgery, thereby initiating and guiding corrective interventions. Design: Retrospective study. Setting: Tertiary care hospital. Participants: A total of 128 consecutive patients who underwent off-pump surgery for congenital heart disease and were monitored with NIRS between April 2021 and April 2024 in the department of pediatric cardiac sciences at a single tertiary care hospital. Interventions: Changes in NIRS values of >20% from the baseline were considered significant. Detection of significant abnormalities in NIRS values was recorded in the electronic patient record (EPR) along with the time of occurrence. Any surgical, ventilatory, or hemodynamic intervention that was prompted by the change in NIRS values was also noted in the EPR along with time frame involved. Measurements and Main Results: Approximately 10/128 (8%) patients demonstrated a significant change in NIRS. Based on the types of operations being performed, patients were grouped into six categories requiring specific corrective interventions that led to gradual correction in NIRS values along with hemodynamic stability. Conclusions: Routine intraoperative and postoperative NIRS monitoring in off-pump congenital cardiac surgeries can help in prompt detection of impending tissue hypoxic injury. It also serves as a real-time guide to assess the therapeutic effects of corrective steps taken after detection of tissue hypoxia thereby improving operative and intensive care outcomes.