scholarly journals Potential Relationship between Cerebral Fractional Tissue Oxygen Extraction (FTOE) and the Use of Sedative Agents during the Perioperative Period in Neonates and Infants

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 209
Author(s):  
Danguolė Č Rugytė ◽  
Loreta Strumylaitė
Keyword(s):  
Quantile Regression ◽  
Near Infrared ◽  
Total Duration ◽  
Oxygen Demand ◽  
Oxygen Extraction ◽  
Tissue Oxygen ◽  
Arterial Blood ◽  
The Mean ◽  
Neonates And Infants ◽  
Sedative Agents

Fractional tissue oxygen extraction (FTOE) by means of cerebral near-infrared spectroscopy (NIRS) provides information about oxygen uptake in the brain. Experimental animal data suggest that sedative agents decrease cerebral oxygen demand. The aim of the present study was to investigate the association between the cerebral FTOE and the use of pre and intraoperative sedative agents in infants aged 1–90 days. Cerebral NIRS was continuously applied during open major non-cardiac surgery in 46 infants. The main outcomes were the mean intraoperative FTOE and the percentage (%) of time of intraoperative hyperoxiaFTOE relative to the total duration of anesthesia. HyperoxiaFTOE was defined as FTOE ≤ 0.1. Cumulative doses of sedative agents (benzodiazepines and morphine), given up to 24 h preoperatively, correlated with the mean intraoperative FTOE (Spearman’s rho = −0.298, p = 0.0440) and were predictive for the % of time of intraoperative hyperoxiaFTOE (β (95% CI) 47.12 (7.32; 86.92)) when adjusted for the patients’ age, type of surgery, preoperative hemoglobin, intraoperative sevoflurane and fentanyl dose, mean intraoperative arterial blood pressure, and end-tidal CO2 by multivariate 0.75 quantile regression. There was no association with 0.5 quantile regression. We observed the suggestive positive association of decreased fractional cerebral tissue oxygen extraction and the use of sedative agents in neonates and infants undergoing surgery.

Effects of Single Loading Dose of Intravenous Caffeine on Cerebral Oxygenation in Preterm Infants

2020 ◽  
Author(s):  
Ozkan Ilhan ◽  
Meltem Bor
Keyword(s):  
Preterm Infants ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Clinical Importance ◽  
Oxygen Extraction ◽  
Loading Dose ◽  
Tissue Oxygen ◽  
Cerebral Tissue ◽  
Baseline Values ◽  
A Prospective Study

Abstract Objective The aim of this study was to evaluate the effects of caffeine on cerebral oxygenation in preterm infants. Study Design This was a prospective study of infants with a gestational age (GA) of < 34 weeks who were treated intravenously with a loading dose of 20 mg/kg caffeine citrate within the first 48 hours of life. Regional cerebral oxygen saturation (rSO2C) and cerebral fractional tissue oxygen extraction (cFTOE) were measured using near-infrared spectroscopy before administering caffeine (baseline), immediately after administering caffeine, and 1, 2, 3, 4, 6, and 12 hours after dose completion; postdose values were compared with the baseline values. Results A total of 48 infants with a mean GA of 29.0 ± 1.9 weeks, birth weight of 1,286 ± 301 g, and postnatal age of 32.4 ± 11.3 hours were included in the study. rSO2C significantly decreased from 81.3 to 76.7% soon after administering caffeine, to 77.1% at 1 hour, and to 77.8% at 2 hours with recovery at 3 hours postdose. rSO2C was 80.2% at 12 hours postdose. cFTOE increased correspondingly. Although rSO2C values were lower and cFTOE values were higher compared with the baseline values at 3, 4, 6, and 12 hours after caffeine administration, this was not statistically significant. Conclusion A loading dose of caffeine temporarily reduces cerebral oxygenation and increases cerebral tissue oxygen extraction in preterm infants. Most probably these changes reflect a physiological phenomenon without any clinical importance to the cerebral hemodynamics, as the reduction in cerebral oxygenation and increase in cerebral tissue oxygen extraction remain well within acceptable range.

scholarly journals Tissue oxygen saturation changes and postoperative complications in cardiac surgery: a prospective observational study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sabino Scolletta ◽  
Federico Franchi ◽  
Elisa Damiani ◽  
Armando Cennamo ◽  
Roberta Domizi ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Observational Study ◽  
Oxygen Saturation ◽  
Prospective Observational Study ◽  
Near Infrared ◽  
Oxygen Extraction ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen ◽  
University Hospitals ◽  
Microvascular Reactivity

Abstract Background Cardiac surgery with extracorporeal circulation (ECC) can induce microvascular dysfunction and tissue hypoperfusion. We hypothesized that the alterations in near-infrared spectroscopy (NIRS)-derived parameters would be associated with post-operative complications in cardiac surgery patients. Methods Prospective observational study performed at two University Hospitals. Ninety patients undergoing cardiac surgery with ECC were enrolled. The NIRS sensor was applied on the thenar eminence. A vascular occlusion test (VOT, 3-min ischemia) was performed at baseline (t0), at Intensive Care Unit (ICU) admission (t1), 3 (t2) and 6 (t3) hours later. Baseline tissue oxygen saturation (StO2), oxygen extraction rate and microvascular reactivity indices were calculated. Results In the first hours after cardiac surgery, StO2 tended to increase (86% [80–89] at T3 versus 82% [79–86] at T0, p = ns), while both tissue oxygen extraction and microvascular reactivity tended to decrease, as indicated by increasing occlusion slope (− 8.1%/min [− 11.2 to − 7] at T3 versus − 11.2%/min [− 13.9 to − 7.9] at T0, p = ns) and decreasing recovery slope (1.9%/sec [1.1–2.9] at T3 versus 3.1%/sec [2.3–3.9] at T0, p = ns). No substantial differences were found in NIRS-derived variables and their changes over time between patients with complications and those without complications. Conclusions Peripheral tissue oxygen extraction and microvascular reactivity were reduced during the first hours after cardiac surgery. NIRS-derived parameters were not able to predict complications in this population of cardiac surgery patients.

scholarly journals Optimizing Cerebral Autoregulation May Decrease Neonatal Regional Hypoxic-Ischemic Brain Injury

2016 ◽  
Vol 39 (1-4) ◽  
pp. 248-256 ◽  
Author(s):  
Jennifer K. Lee ◽  
Andrea Poretti ◽  
Jamie Perin ◽  
Thierry A.G.M. Huisman ◽  
Charlamaine Parkinson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Brain Injury ◽  
White Matter ◽  
Near Infrared ◽  
Birth Asphyxia ◽  
Neurologic Injury ◽  
Ischemic Brain ◽  
Arterial Blood ◽  
Blood Pressures ◽  
The Mean

Background: Therapeutic hypothermia provides incomplete neuroprotection for neonatal hypoxic-ischemic encephalopathy (HIE). We examined whether hemodynamic goals that support autoregulation are associated with decreased brain injury and whether these relationships are affected by birth asphyxia or vary by anatomic region. Methods: Neonates cooled for HIE received near-infrared spectroscopy autoregulation monitoring to identify the mean arterial blood pressure with optimized autoregulatory function (MAPOPT). Blood pressure deviation from MAPOPT was correlated with brain injury on MRI after adjusting for the effects of arterial carbon dioxide, vasopressors, seizures, and birth asphyxia severity. Results: Blood pressure deviation from MAPOPT related to neurologic injury in several regions independent of birth asphyxia severity. Greater duration and deviation of blood pressure below MAPOPT were associated with greater injury in the paracentral gyri and white matter. Blood pressure within MAPOPT related to lesser injury in the white matter, putamen and globus pallidus, and brain stem. Finally, blood pressures that exceeded MAPOPT were associated with reduced injury in the paracentral gyri. Conclusions: Blood pressure deviation from optimal autoregulatory vasoreactivity was associated with MRI markers of brain injury that, in many regions, were independent of the initial birth asphyxia. Targeting hemodynamic ranges to optimize autoregulation has potential as an adjunctive therapy to hypothermia for HIE.

Effects of Caffeine on Splanchnic Oxygenation in Preterm Infants

2020 ◽  
Author(s):  
Ozkan Ilhan ◽  
Meltem Bor
Keyword(s):  
Infrared Spectroscopy ◽  
Preterm Infants ◽  
Near Infrared ◽  
Oxygen Extraction ◽  
Partial Recovery ◽  
Loading Dose ◽  
Tissue Oxygen ◽  
Caffeine Citrate ◽  
Splanchnic Oxygenation ◽  
Splanchnic Oxygen

Abstract Objective The aim of this study is to assess the effects of administering 20 mg/kg loading dose of caffeine citrate intravenously on splanchnic oxygenation in preterm infants. Study Design The infants with a gestational age (GA) of <34 weeks who were administered with a 20 mg/kg intravenous loading dose of caffeine citrate within 48 hours after birth were investigated prospectively. Regional splanchnic oxygen saturation (rsSO2) and splanchnic fractional tissue oxygen extraction rate (sFTOE) were measured using near-infrared spectroscopy before caffeine infusion, immediately after caffeine infusion and 1, 2, 3, 4, and 6 hours (h) after dose completion; postdose values were compared with predose values. Results A total of 41 infants with a mean GA of 29.2 ± 1.6 weeks and birth weight of 1,315 ± 257 g as well as postnatal age of 32.2 ± 10.8 hours were included in the study. rsSO2 significantly reduced from 63.1 to 57.5% immediately after caffeine infusion, 55.1% after 1 hour, and 55.2% after 2 hours with partial recovery at 3-hour postdose. sFTOE increased correspondingly. Conclusion Caffeine reduces splanchnic oxygenation and increases splanchnic oxygen extraction for at least 2 hours with partial recovery to predose levels at 3-hour postdose.

scholarly journals Near-infrared spectroscopy for assessing the tissue oxygen extraction rate during sepsis: relationship with outcome

Critical Care ◽  
2015 ◽  
Vol 19 (Suppl 1) ◽  
pp. P143
Author(s):  
A Donati ◽  
E Damiani ◽  
C Scorcella ◽  
S Tondi ◽  
S Ciucani ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Extraction Rate ◽  
Oxygen Extraction ◽  
Tissue Oxygen

scholarly journals Regional Tissue Oxygen Extraction and Severity of Anemia in Very Low Birth Weight Neonates: A Pilot NIRS Analysis

2018 ◽  
Vol 35 (14) ◽  
pp. 1411-1418 ◽  
Author(s):  
Jonathan Mintzer ◽  
Boriana Parvez ◽  
Edmund La Gamma
Keyword(s):  
Birth Weight ◽  
Near Infrared ◽  
Very Low Birth Weight ◽  
Oxygen Extraction ◽  
Cerebral Oxygen ◽  
Tissue Oxygen ◽  
Premature Neonates ◽  
Splanchnic Oxygen ◽  
Metabolic Behavior ◽  
Blood Flow Redistribution

Objective Anemia causes blood flow redistribution and altered tissue metabolic behavior to sustain homeostatic oxygen consumption. We hypothesized that anemia severity would correlate with increased regional fractional tissue oxygen extraction among premature neonates. Study Design Regional oxygen extraction was calculated using pulse oximetry and near-infrared spectroscopy data among neonates <1,250 g during their first 10 postnatal days. Oxygen extraction was assessed for correlations with raw hematocrit levels and following grouping into hematocrit quartiles. Results Twenty-seven neonates with gestational age 27 ± 2 weeks and birth weight 966 ± 181 g underwent 116 hematocrit determinations. Cerebral and flank oxygen extraction inversely correlated with hematocrit (cerebral r = −0.527, p = 0.005; flank r = −0.485, p = 0.01). Increased cerebral oxygen extraction was observed for the lowest three hematocrit quartiles (Q1 0.26 ± 0.08, p = 0.004; Q2 0.24 ± 0.09, p = 0.01; Q3 0.25 ± 0.09, p = 0.03; all compared with Q4 0.18 ± 0.10). Increased flank oxygen extraction occurred for the lowest two quartiles (Q1 0.36 ± 0.12, p < 0.001; Q2 0.35 ± 0.11, p < 0.001; compared with Q4 0.22 ± 0.13). Splanchnic oxygen extraction demonstrated no similar correlations. Conclusion Increases in tissue oxygen extraction may indicate early pathophysiologic responses to nascent anemia in premature neonates.

scholarly journals Effect of Auditory Maturation on the Encoding of a Speech Syllable in the First Days of Life

2021 ◽  
Vol 11 (7) ◽  
pp. 844
Author(s):  
Laís Ferreira ◽  
Piotr Henryk Skarzynski ◽  
Magdalena Beata Skarzynska ◽  
Milaine Dominici Sanfins ◽  
Eliara Pinto Vieira Biaggio
Keyword(s):  
Language Development ◽  
Speech Sound ◽  
Normal Hearing ◽  
Auditory Maturation ◽  
Significant Difference ◽  
Sound Changes ◽  
The Mean ◽  
Neonates And Infants

(1) Background: In neonates and infants, the physiological modifications associated with language development are reflected in their Frequency Following Responses (FFRs) in the first few months of life. (2) Objective: This study aimed to test the FFRs of infants in the first 45 days of life in order to evaluate how auditory maturation affects the encoding of a speech syllable. (3) Method: In total, 80 healthy, normal-hearing infants, aged 3 to 45 days old, participated in this study. The sample was divided into three groups: GI, 38 neonates from 3 to 15 days; GII, 25 infants from 16 to 30 days; and GIII, 17 infants from 31 to 45 days. All participants underwent FFR testing. Results: With age, there was a decrease in the latency of all FFR waves, with statistically significant differences among the groups studied for waves V, A, E, F, and O. The mean amplitudes showed an increase, with a statistically significant difference only for wave V. The slope measure increased over the 45 days, with a statistically significant difference between GIII and GI and between GIII and GII. (4) Conclusions: The encoding of a speech sound changes with auditory maturation over the first 45 days of an infant’s life.

scholarly journals Elimination of nasal obstruction improves pulmonary functions and oxygenation

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Eman Sobh ◽  
Fatma Elhussieny ◽  
Taghreed Ismail
Keyword(s):  
Nasal Obstruction ◽  
Blood Gases ◽  
Medical Problem ◽  
Forced Expiratory Volume ◽  
Nasal Packing ◽  
Nasal Pack ◽  
Arterial Blood ◽  
Study Population ◽  
The Mean ◽  
The Impact

Abstract Background Nasal obstruction is a significant medical problem. This study aimed to examine the effect of nasal obstruction and nasal packing on arterial blood gases and pulmonary function indices, and the impact of the elimination of nasal obstruction on preoperative values. Results The mean age of the study population was 26.6 ± 10.1 years, males represented 50.8%. Spirometric indices showed statistically significant improvement (preoperative forced expiratory volume in 1st second 66.9 ± 13.9 vs 79.6 ± 14.9 postoperative and preoperative forced vital capacity 65.5 ± 12.7 vs 80.4 ± 13.8 postoperative). Oxygen saturation was significantly lower during nasal packing (95.6 ± 1.6 preoperative vs 94.7 ± 2.8 with nasal pack), and significant improvement (97.2 ± 1.4) was observed after removal of the nasal pack. Nasal obstruction scores significantly improved. Conclusion The results of this study indicate that either simple nasal obstruction or nasal packing may cause hypoxemia and abnormalities in lung function tests. Hypoxemia was more evident with nasal packing.

scholarly journals Pathophysiology and clinical consequences of arterial blood gases and pH after cardiac arrest

2020 ◽  
Vol 8 (S1) ◽  
Author(s):  
Chiara Robba ◽  
Dorota Siwicka-Gieroba ◽  
Andras Sikter ◽  
Denise Battaglini ◽  
Wojciech Dąbrowski ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Cardiac Arrest ◽  
Oxygen Demand ◽  
Blood Gases ◽  
Metabolic Energy ◽  
High Morbidity ◽  
Arterial Blood Gases ◽  
Arterial Blood ◽  
Clinical Consequences

AbstractPost cardiac arrest syndrome is associated with high morbidity and mortality, which is related not only to a poor neurological outcome but also to respiratory and cardiovascular dysfunctions. The control of gas exchange, and in particular oxygenation and carbon dioxide levels, is fundamental in mechanically ventilated patients after resuscitation, as arterial blood gases derangement might have important effects on the cerebral blood flow and systemic physiology.In particular, the pathophysiological role of carbon dioxide (CO2) levels is strongly underestimated, as its alterations quickly affect also the changes of intracellular pH, and consequently influence metabolic energy and oxygen demand. Hypo/hypercapnia, as well as mechanical ventilation during and after resuscitation, can affect CO2 levels and trigger a dangerous pathophysiological vicious circle related to the relationship between pH, cellular demand, and catecholamine levels. The developing hypocapnia can nullify the beneficial effects of the hypothermia. The aim of this review was to describe the pathophysiology and clinical consequences of arterial blood gases and pH after cardiac arrest.According to our findings, the optimal ventilator strategies in post cardiac arrest patients are not fully understood, and oxygen and carbon dioxide targets should take in consideration a complex pattern of pathophysiological factors. Further studies are warranted to define the optimal settings of mechanical ventilation in patients after cardiac arrest.

Sign in / Sign up

Export Citation Format

Share Document