(768) Feasibility of Real-Time Near-Infrared Spectroscopy Monitoring During Tracheal intubation

Monday, January 22, 2024

11:30 AM – 12:30 PM MT

Location: Connections Central - RST 05

First Author(s)

Ting-Chang Hsieh, MD

Pediatric Intensivist
West Virginia University Children's Hospital
Morgantown, West Virginia

Co-Author(s)

AA

Awni Al-Subu, MD

Associate Professor
University of Wisconsin Hospitals and Clinics
Madison, Wisconsin, United States
SH

Scott Hagen, MD

Professor
University of Wisconsin Hospitals and Clinics
Madison, Wisconsin, United States
ML

Michael Lasarev, MS

Biostatistician
University of Wisconsin Hospitals and Clinics
Madison, Wisconsin, United States

Introduction: Tracheal intubation (TI) poses risks for critically ill patients, necessitating effective monitoring. Near-infrared spectroscopy (NIRS) enables oxygen supply-demand monitoring in pediatric cardiac surgery. This study examines the feasibility of multi-site NIRS monitoring during TI for pediatric patients with congenital heart disease (CHD). We hypothesized that multi-site NIRS monitoring during TI is feasible in pediatric patients with congenital heart disease (CHD) scheduled for cardiac surgery

Methods: A prospective single center observational study enrolled CHD patients scheduled for cardiac surgery. NIRS data were collected during TI using an NIRS monitor, alongside vital signs during TI and until 60 minutes past anesthetic induction. Jonckheere's test was used to assess the relative frequency of desaturation events and associations with TI attempts.

Results: 64 intubation encounters (56 patients) were analyzed. NIRS readings were available in 58% of encounters at the beginning of encounter and 82% (95% CI: 71.6–90.2%) of NIRS readings were recorded within 5 minutes. First intubation attempts had a 75% success rate. NIRS desaturations occurred in 55% of encounters. Higher somatic tissue oxygenation (srO2) desaturation rates were observed in cyanotic (43.2%, 95% CI: 31.5–59.5%) versus acyanotic CHD patients (25.0% 95% CI: 16.0–38.9%). Cerebral rO2 desaturation rates were higher in acyanotic CHD patients (17.5% 95% CI: 10.0-30.4%) compared to cyanotic CHD patients (1.92% 95% CI: 24.4-46.4%). No significant difference was observed in NIRS desaturation events before and after intubation (p = 0.992).

Conclusions: Multi-site NIRS monitoring during intubation for pediatric CHD patients is feasible. Though consistent NIRS monitoring was challenging, NIRS desaturations were common during intubation, with variations between cyanotic and acyanotic CHD groups. Further research is needed to validate these findings and determine their clinical significance.