DESIGN OF A PROTOCOL-DRIVEN ALGORITHM TO IMPROVE AND ASSESS THE UTILITY OF NEAR-INFRARED SPECTROSCOPY (NIRS) IN THE CARDIAC INTENSIVE CARE UNIT (CICU)
- Javier Alvarez-Gavela, United Kingdom
- Javier Alvarez-Gavela, United Kingdom
- Ulyana Winfield,
- Cho Ng,
- Aparna Hoskote, United Kingdom
Abstract
Background
NIRS is widely used in paediatric cardiac surgery to monitor cerebral perfusion. It is increasingly used in the postoperative period, however there are no universally accepted guidelines on use and interpretation.
Objectives
We reviewed existing literature and designed a protocol in the CICU for NIRS monitoring and intervention. Our main objective was to determine if protocol-driven NIRS monitoring can help early recognition of haemodynamic instability and neurological compromise.
Methods
We designed algorithms for 3 distinct patient populations: 1) Bilateral cerebral monitoring for those supported on extracorporeal membrane oxygenation (ECMO) and 2) Cerebral and somatic (renal) monitoring in those post-cardiac surgery. Different NIRS targets and intervention thresholds were developed for the 2 post-operative patient groups: univentricular and biventricular physiology with incorporation of clinical, biochemical and imaging parameters that would help identify the cause for NIRS desaturation.
Results
The protocol was peer-reviewed and implemented after adequate staff training. While electronic data collection is ongoing, to date we identified one patient on ECMO who developed seizures and was found to have a unilateral intracranial bleed. The cerebral saturation was persistently low with a 20% drop on affected side with no change on the opposite side preceding the seizures by a few hours. Having a protocol has increased NIRS usage in a meaningful way for high-risk patients.
Conclusion
Use of NIRS is controversial given concerns regarding reliability and difficult interpretation with no published intervention algorithms. The algorithms that we have developed will help determine the potential usefulness of NIRS monitoring in the CICU.