Effects of ventilation modalities on near-infrared spectroscopy in surgically corrected CDH infants

Background Near-infrared spectroscopy (NIRS) is a noninvasive technique for monitoring tissue oxygenation and perfusion. The aim of this study was to evaluate cerebral and splanchnic NIRS changes in CDH operated infants enrolled into the VICI trial and therefore randomized for ventilatory modalities. Materials and methods CDH newborns enrolled into the VICI trial (Netherlands Trial Register, NTR 1310) were randomized at birth for high-frequency oscillatory ventilation (HFOV) or conventional mechanical ventilation (CMV) according to the trial. Cerebral oxygenation (rSO₂C) and splanchnic oxygenation (rSO₂S) were obtained by NIRS (INVOS 5100; Somanetics, Troy, MI) before and after surgery. Variations in rSO₂C and rSO₂S were evaluated. Mann-Whitney test and one-way ANOVA were used as appropriate. p <0.05 was considered significant. Results Thirteen VICI trial patients underwent surgical repair between March 2011 and December 2012, and were enrolled in the study. Seven patients were assigned to HFOV and six to CMV group respectively. During surgery, a significant reduction in rSO₂C (p = 0.0001) and rSO₂S (p = 0.005) were observed. HFOV patients experienced prolonged reduction in rSO₂C value (p = 0.003) while rSO₂S did not vary between HFOV and CMV (p = 0.94). Conclusions Surgical CDH repair was associated with decrease of cerebral and splanchnic oxygenation, regardless of ventilation. Patients ventilated by HFOV need a longer time interval to recovery normal rSO₂C values, than those ventilated by CMV. This may be owing to a different impact of HFOV on patients' hemodynamic status with a higher impairment on total venous return and its negative consequences on cardiac output.