Eh. Austin et al., BENEFIT OF NEUROPHYSIOLOGIC MONITORING FOR PEDIATRIC CARDIAC-SURGERY, Journal of thoracic and cardiovascular surgery, 114(5), 1997, pp. 707-715
Background. Pediatric patients undergoing repair of congenital cardiac
approved by the institutional review board, electroencephalography, t
ranscranial Doppler ultrasonic measurement of middle cerebral artery b
lood flow velocity, and transcranial near-infrared cerebral oximetry w
ere monitored in 250 patients, An interventional algorithm was used to
detect and correct specific deficiencies in cerebral perfusion or oxy
genation or to increase cerebral tolerance to ischemia or hypoxia. Res
ults: Noteworthy changes in brain perfusion or metabolism were observe
d in 176 of 250 (70%) patients, Intervention that altered patient mana
gement was initially deemed appropriate in 130 of 176 (74%) patients w
ith neurophysiologic changes, Obvious neurologic sequelae (i.e., seizu
re, movement, vision or speech disorder) occurred in five of 74 (7%) p
atients without noteworthy change, seven of 130 (6%) patients with int
ervention, and 12 of 46 (26%) patients without intervention (p = 0.001
), Survivors' median length of stay was 6 days in the no-change and in
tervention groups but 9 days in the no-intervention group, In addition
, the percentage of patients in the no-intervention group discharged f
rom the hospital within 1 week (32%) was significantly less than that
in either the intervention (51%, p = 0.05) or no-change (58%, p = 0.01
) groups, On the basis of an estimated hospital neurologic complicatio
n cost of $1500 per day, break-even analysis justified a hospital expe
nditure for neurophysiologic monitoring of $2142 per case, Conclusions
: Interventions based on neurophysiologic monitoring appear to decreas
e the incidence of postoperative neurologic sequelae and reduce the le
ngth of stay, Inasmuch as the break-even cost for neurophysiologic mon
itoring is more than four times the actual average charge, both patien
ts and hospital may profit from this service. Because this study was n
ot a truly randomized clinical trial, unintentional statistical bias m
ay have occurred and caution is urged in interpreting the magnitude of
apparent intergroup outcome differences.