Benefit of neurophysiologic monitoring for pediatric cardiac surgery

摘要: Background. Pediatric patients undergoing repair of congenital cardiac abnormalities have a significant risk an adverse neurologic event. Therefore this retrospective cohort study examined the potential benefit interventions based on intraoperative neurophysiologic monitoring in decreasing both postoperative sequelae and length hospital stay as cost proxy. Methods: With informed parental consent approved by institutional review board, electroencephalography, transcranial Doppler ultrasonic measurement middle cerebral artery blood flow velocity, near-infrared oximetry were monitored 250 patients. An interventional algorithm was used to detect correct specific deficiencies perfusion or oxygenation increase tolerance ischemia hypoxia. Results: Noteworthy changes brain metabolism observed 176 (70%) Intervention that altered patient management initially deemed appropriate 130 (74%) with changes. Obvious (i.e., seizure, movement, vision speech disorder) occurred five 74 (7%) without noteworthy change, seven (6%) intervention, 12 46 (26%) intervention (p = 0.001). Survivors' median 6 days no-change groups but 9 no-intervention group. In addition, percentage group discharged from within 1 week (32%) significantly less than either (51%, p 0.05) (58%, 0.01) groups. On basis estimated complication $1500 per day, break-even analysis justified expenditure for $2142 case. Conclusions: Interventions appear decrease incidence reduce stay. Inasmuch is more four times actual average charge, may profit service. Because not truly randomized clinical trial, unintentional statistical bias caution urged interpreting magnitude apparent intergroup outcome differences. (J Thorac Cardiovasc Surg 1997;114:707-17)