Role of near infrared spectroscopy in pediatric cardiac surgery

Initial interest in near infrared spectroscopy for the prevention of neurological injury during cardiac surgery focused on intra-operative cerebral oximetry monitoring to minimize the potential negative impact of cardiopulmonary bypass and various perfusion strategies. However, it has become increasingly apparent, over the past decade, that neurological function can be impacted throughout the peri-operative period, particularly in the intensive care unit environment (Ballweg et al., 2007 [1]). As a result, the application of near infrared spectroscopy has expanded beyond the operating room to a variety of clinical arenas, including the intensive care unit and even the outpatient setting. In addition, the clinical indications have expanded to include multi-site, continuous monitoring for detection of low cardiac output states and regional tissue hypoxia of tissue beds other than the cerebral circulation.The precise role for near infrared spectroscopy in the pediatric cardiac surgery population remains unclear. While there is a growing body of evidence demonstrating its correlation with other physiologic markers, such as SvO2, currently there are limited data to support that clinical decision-making based on near infrared spectroscopy improves patient outcomes. In assessing the potential role of near infrared spectroscopy monitoring in congenital heart disease, it is important to emphasize its unique qualities, including noninvasive, continuous, and real-time measurement of regional tissue oxygen saturation, and its potential earlier, faster and more accurate physiologic assessments to direct patient care, monitor response to therapeutic intervention, and ultimately to improve long term outcomes.