Comparison of regional transcranial oximetry with near infrared spectroscopy (NIRS) and jugular venous bulb oxygen saturation for the monitoring of cerebral oxygenation in infants and children

Using a dual channel near infrared (NIR) in vivo optical spectroscopy (INVO S(R)) system (INVOS 3100A(R), Somanetics Corp. Troy, MI, USA) we investigat ed the relationship between jugular venous oxygen saturation (SjvO(2)) and regional cerebral oxygen saturation (rSO(2)) in 30 infants and children (me an age 4.5 years) with congenital heart disease undergoing cardiac catheter isation. The NIRS-SomaSensor(R) (emitter and dual receiver probe) was appli ed at a standardised right fronto-temporal location lover the right frontal cortex) on the infant's head and covered with an adhesive flexible bandage Using NIR Light (730 and 810 nm) and two source-detector spacings (3 and 4 cm from the transmitter), percentage values of rSO(2) were calculated from detected haemoglobin saturations. Simultaneously, jugular venous oxygen sa turation (SjvO(2)) monitoring was performed via a catheter placed in the ri ght internal jugular vein with its tip positioned in the jugular bulb, as v erified by fluoroscopy. To compare the reliability of NIRS measurement char acteristics, jugular venous blood was analysed for SjvO(2) as a reference m easure of global cerebral oxygenation, by co-oximetry (OSM3-Hemoximeter(R), Radiometer Copenhagen, Denmark). Other measured variables included pulse o ximetry, arterial blood pressure, and venous and arterial oxygen saturation s. Over a jugular venous oxygen saturation range of 31-83%, a significant p ositive linear correlation was found between rSO(2) (NIRS measurement) and SjvO(2) (jugular bulb oximetry) (r = 0.93, p < 0.001). No significant corre lation was observed between rSO(2) values and arterial blood saturation or pulse oximetry. The quantitative correlation between rSO(2) (haemoglobin ox ygenation in a small hemi-elliptical area of the brain) and reference SjvO( 2) measurement (method for monitoring global cerebral oxygenation) suggests that NIRS measurement with subtraction algorithm should identify predomina ntly intracranial saturation in the pediatric age group, and will tend to r eflect global oxygenation under physiological conditions. Transcranial oxim etry using dual receiving channel NIRS offers a noninvasive, real-time, rel iable and practicable means of monitoring cerebral haemoglobin oxygenation changes infants and children with cyanotic and noncyanotic congenital heart disease.