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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Near-infrared spectroscopy what we know and what we need to know: a systematic review of the congenital heart disease literature

JC Hirsch, JR Charpie, RG Ohye, and JG Gurney.

Review published: 2009.

Link to full article: [Journal publisher]

CRD summary

This review concluded that multimodality monitoring including near-infrared spectroscopy may be a useful adjunct to care, but evidence for improvements in neurological outcome was lacking. Aspects of the review were poorly reported and it had some methodological problems, but the caution of the conclusions means that they are probably reliable, despite these concerns.

Authors' objectives

To assess the evidence for the use of near-infrared spectroscopy in paediatric patients with congenital heart disease.

Searching

MEDLINE, EMBASE and The Cochrane Library databases were searched from 1950 to April 2007. Search terms were reported. References of narrative reviews were checked. Only studies reported in English were eligible for inclusion in the review.

Study selection

Studies of near-infrared spectroscopy in paediatric patients with congenital heart disease from any area of paediatric cardiology or cardiac surgery were eligible for inclusion. Primary studies of any design with the exception of single case reports were eligible.

Included studies assessed the following devices: INVOS, NIRO, NIMS, Radiometer, PSA-3N and InSpectra Tissue Spectrometer. Patients had a variety of types of congenital heart disease and underwent a range of surgical procedures. Studies took place in the intraoperative setting, in intensive care or in the cardiac catheterisation laboratory. Most studies reported on perfusion changes; only a minority evaluated the association between near-infrared spectroscopy and clinical outcomes.

The authors state neither how the papers were selected for the review nor how many reviewers performed the selection.

Assessment of study quality

The authors did not state that they assessed validity.

Data extraction

One reviewer performed the data extraction.

Methods of synthesis

The studies were combined in a narrative synthesis, supported by evidence tables, due to clinical and methodological heterogeneity. Studies were grouped by setting (intraoperative, intensive care or cardiac catheterisation laboratory).

Results of the review

Fifty-four studies (n=1,845) were included in the review: five randomised controlled trials (RCTs) (n=178); three were retrospective studies (n=439); one pre-post design (n=8); and 45 case series (n=1,220). Only two studies had planned post-hospital follow up (at three months).

Intraoperative (38 studies, four RCTs): Only three studies reported the relationship between near-infrared spectroscopy and clinical outcomes. One retrospective study (n=34) found that patients who died after a single ventricle first-stage palliation had lower regional oxygen saturation at the end of the operation (p<0.01), but there was no correlation to clinical neurologic abnormalities. Two case series found associations between decreased regional oxygen saturation and abnormalities in postoperative magnetic resonance imaging (MRI) scans; one of these showed a significant association between low regional oxygen saturation and new or worsening lesions (n=22, p=0.029).

Intensive care (11 studies, one crossover RCT): None of the studies reported the relationship between near-infrared spectroscopy and clinical outcomes or neurological follow-up. The common findings in the studies which examined correlations with other outcomes related to oxygenation were that there was a large amount of variability both between and within individuals.

Cardiac catheterisation laboratory (seven studies): None of the studies reported the relationship between near-infrared spectroscopy and clinical outcomes or neurological follow-up. The common findings in the studies that examined correlations with other outcomes related to oxygenation were that there was a large amount of variability both between and within individuals.

Authors' conclusions

The data suggested that multimodality monitoring including near-infrared spectroscopy may be a useful adjunct to care, but did not demonstrate improvements in neurological outcome.

CRD commentary

The authors searched three relevant databases and some other sources, but did not systematically search for unpublished studies. This, as well as the restriction to studies published in English, may have led to the exclusion of some relevant studies and the introduction of publication and language biases. The authors did not report using methods designed to reduce reviewer bias and error at any stage of the review process. They also did not assess the validity of the included studies, which made the reliability of the evidence difficult to determine. The designs of most of the included studies were also weak, with case series predominant. The decision to use a narrative synthesis was appropriate given the clinical and methodological heterogeneity of the studies. The authors' conclusions accurately reflected the limited evidence of the review. However, there were a number of problems with the review process and reporting, meaning that the reliability of the conclusions is unclear.

Implications of the review for practice and research

Practice: The authors stated that although near-infrared spectroscopy had promise for measuring regional tissue oxygen saturation, the lack of data demonstrating improved outcomes limited support for widespread implementation.

Research: Rigorous clinical trials should be performed to demonstrate improved clinical outcomes with the addition of near-infrared spectroscopy monitoring in paediatric patients with congenital heart disease before it was implemented universally.

Funding

Michigan Congenital Heart Outcomes Research and Discovery Unit, Department of Surgery, University of Michigan.

Bibliographic details

Hirsch J C, Charpie J R, Ohye R G, Gurney J G. Near-infrared spectroscopy what we know and what we need to know: a systematic review of the congenital heart disease literature. Journal of Thoracic and Cardiovascular Surgery 2009; 137(1): 154-159. [PubMed: 19154918]

Indexing Status

Subject indexing assigned by NLM

MeSH

Child, Preschool; Heart Defects, Congenital /metabolism /surgery; Humans; Infant; Intensive Care; Monitoring, Intraoperative; Spectroscopy, Near-Infrared

AccessionNumber

12009103119

Database entry date

19/08/2009

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 19154918

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