Multisite Near-Infrared Spectroscopy Predicts Elevated Blood Lactate Level in Children After Cardiac Surgery

Objectives: To determine if a relationship exists between regional oxyhemoglobin saturation (rSO(2)) measured at various body locations by near-infrared spectroscopy (NIRS) and blood lactate level in children after cardiac surgery. Design: A prospective, observational study. Setting: A pediatric cardiac intensive care unit in a university hospital. Participants: Twenty-three children undergoing repair of congenital heart disease. Patients with single-ventricle physiology and/or residual intracardiac shunts were excluded. Interventions: None. Measurements and Main Results: Cerebral, splanchnic, renal, and muscle rSO(2) values were recorded every 30 seconds via MRS for 24 hours postoperatively. Blood lactate levels measured minimally at 0, 2, 4, 6 and 24 hours postoperatively were correlated with rSO(2) values derived by averaging all values recorded during the 60 minutes preceding the blood draw. Twenty-three patients were enrolled with 163 lactate measurements and more than 39,000 rSO(2) observations analyzed. Cerebral rSO(2) had the strongest inverse correlation with lactate level followed by splanchnic, renal, and muscle rSO(2) (r = -0.74, p < 0.0001, r = -0.61, p < 0.0001, r = -0.57, p < 0.0001, and r = -0.48, p < 0.0001, respectively). The correlation improved by averaging the cerebral and renal rSO(2) values (r = -0.82, p < 0.0001). Furthermore, an averaged cerebral and renal rSO(2) value <= 65% predicted a lactate level >= 3.0 mmol/L with a sensitivity of 95% and a specificity of 83% (p = 0.0001). Conclusions: Averaged cerebral and renal rSO(2) less than 65% as measured by MRS predicts hyperlactatemia (>3 mmol/L) in acyanotic children after congenital heart surgery. Hence, this noninvasive, continuous monitoring tool may facilitate the identification of global hypoperfusion caused by low cardiac output syndrome in this population. (C) 2009 Elsevier Inc. All rights reserved.