Can transcutaneous near infrared spectroscopy detect severe hepatic ischemia: a juvenile porcine model

Summary

Background

Vascular complications following pediatric liver transplantation occur in 8–10% of cases, and no continuous, non-invasive monitoring for this problem exists. Near infrared spectroscopy (NIRS) allows non-invasive, continuous, transcutaneous assessment of hemoglobin oxygenation (StO₂) 1–4 cm below the skin surface.

Aims

We hypothesized that transcutaneous NIRS would be able to detect severe hepatic ischemia, and tested this in an animal model using 15–20 kg and 5–7 kg juvenile pigs.

Materials and Methods

Direct liver surface and transcutaneous hepatic tissue hemoglobin oxygen saturation (StO₂) were measured during occlusions of the hepatic artery and portal vein. Changes in hepatic delivery of oxygen (HepDO₂) were calculated for each ischemic challenge and compared to changes in direct liver surface (DirHepStO₂) and transcutaneous liver StO₂ measurements (CutHepStO₂).

Results

In the 15–20 kg animals during complete occlusion, CutHepStO₂ decreased by 6.0(±4.9)%, whilst DirHepStO₂ decreased by 83.7(±7.2)%. In the 5–7 kg animals during complete occlusion, CutHepStO₂ decreased by 27.4(±8.5)%, whilst DirHepStO₂ decreased by 82.8(±4.6)%.

Conclusion

Transcutaneous hepatic StO₂ monitoring cannot reliably detect severe hepatic ischemia in a juvenile porcine model, although a stronger and potentially useful signal is seen in 5–7 kg pigs. Trials of this technology should be currently restricted to situations where the organ is less than 1 cm from the skin surface, corresponding to infants of <10 kg.

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