Comparing near-infrared spectroscopy-measured cerebral oxygen saturation and corresponding venous oxygen saturations in children with congenital heart disease: a systematic review and meta-analysis

Yiqi Ma; Lihong Zhao; Jiafu Wei; Ziwei Wang; Su Lui; Bin Song; Qiyong Gong; Pu Wang; Min Wu

doi:10.21037/tp-22-345

Comparing near-infrared spectroscopy-measured cerebral oxygen saturation and corresponding venous oxygen saturations in children with congenital heart disease: a systematic review and meta-analysis

Transl Pediatr. 2022 Aug;11(8):1374-1388. doi: 10.21037/tp-22-345.

Authors

Yiqi Ma^#¹, Lihong Zhao^#¹, Jiafu Wei², Ziwei Wang¹, Su Lui¹, Bin Song¹, Qiyong Gong^{1

3}, Pu Wang^{4

5}, Min Wu¹

Affiliations

¹ Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
² Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
³ Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, China.
⁴ Department of Rehabilitation Medicine, The Seventh Hospital of Sun Yat-Sen University, Shenzhen, China.
⁵ Guangdong Engineering Technology Research Center for Rehabilitation Medicine and Clinical Translation, Guangzhou, China.

^# Contributed equally.

Abstract

Background: Near-infrared spectroscopy (NIRS) is a non-invasive approach that measures cerebral regional oxygen saturation (rScO₂). In this study, we evaluated the evidence on the validity of NIRS and the interchangeability between NIRS and common invasive approaches by exploring the correlation and consistency and comparing the mean and standard deviation between the NIRS rScO₂ and jugular bulb venous oxygen saturation (SjvO₂) as well as central venous oxygen saturation (ScvO₂) in the perioperative period of children with congenital heart disease (CHD).

Methods: We searched electronic bibliographic databases (PubMed, The Cochrane Library and Embase) and screened the studies that met the inclusion criteria. We included cross-sectional studies of CHD pediatric patients in the perioperative period receiving both tests for NIRS rScO₂ and SjvO₂ or NIRS rScO₂ and ScvO₂. Methodological quality assessment and heterogeneity analyses were performed. We qualitatively summarized the results of Bland-Altman's analysis. Meta-regression, subgroup analyses, and sensitivity analyses were carried out to explore the causes of heterogeneity.

Results: There was no significant difference in Cohen's d between rScO₂ and ScvO₂ or between rScO₂ and SjvO₂ (Cohen's d =0.06, 95% CI: -0.16 to 0.28; Cohen's d =0.03, 95% CI: -0.25 to 0.31, respectively) and notable heterogeneity existed (I²=76.0%, P<0.001; I²=73.6%, P<0.001, respectively). A positive linear correlation was present between rScO₂ and ScvO₂ or between rScO₂ and SjvO₂ (r=0.58, 95% CI: 0.54 to 0.63; r=0.60, 95% CI: 0.54 to 0.66, respectively) and the heterogeneity was not significant (I²=36.7%, P=0.065; I²=12.7%, P=0.328, respectively). In most studies, the 95% limits of agreements of Bland-Altman's analysis were large. No evidence of publication bias was observed.

Conclusions: The rScO₂ measured by NIRS reflected the SjvO₂ and ScvO₂ monitored by invasive measurements in the perioperative period of children with CHD to some extent. However, wide limits of agreements between rScO₂ and SjvO₂ as well as ScvO₂ indicated that NIRS and SjvO₂ as well as ScvO₂ are not interchangeable. Whether NIRS plays a prominent role in monitoring cerebral oxygen saturation in children with CHD needs further research.

Keywords: Near-infrared spectroscopy (NIRS); central venous oxygen saturation (ScvO2); cerebral oxygen saturation; congenital heart disease (CHD); jugular bulb venous oxygen saturation (SjvO2).