Use of intraoperative cerebral and renal region Near infrared spectroscopy to predict postoperative outcome; a prospective observational study

Background: Postoperative acute kidney injury (AKI) is a frequent complication after cardiac surgery in pediatric patients, ranging from 20 to 86% depending on the population and used definition of AKI. The diagnosis of renal injury is commonly based on creatinine elevation, but this biomarker only increases when an extensive kidney injury has already developed. Literature advises using the KDIGO criteria (combination of serum creatinine values and urine output) to assess the degree of AKI. Since renal hypoperfusion and hypoxia are among the most important insults contributing to postoperative AKI, near-infrared spectroscopy (NIRS), measuring regional tissue saturation (StO2) might prove useful in the real-time detection of renal tissue hypoxia, alerting the clinician to redirect care to prevent a potential ischemic insult and kidney injury.
Main research question: We aim to determine whether cerebral NIRS or renal region NIRS could predict the postoperative incidence of AKI.
Design (including population, confounders/outcomes): Prospective observational pilot study, this is a non-WMO study. The population is infants and children below 18 years of age with non-cyanotic with a left to right shunt congenital heart disease. The outcome is postoperative AKI, defined using the KDIGO criteria (blood creatinine and urine output).

We hypothesize that lower renal region or cerebral NIRS values are correlated with a higher incidence of postoperative AKI in this study population

Multiple; Continuous monitoring intraoperative

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