Journal of cardiothoracic and vascular anesthesia · 2026
Continuous Bilateral Lower-Limb Near-Infrared Spectroscopy Monitoring in Patients on Intra-aortic Balloon Pump Support: A Prospective Feasibility and Physiology Study.
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Woei Wong Shiun, Wenjie Huang, Yan Jiang, Woon Chia Yew
Аннотация
OBJECTIVES: To evaluate the feasibility of continuous bilateral lower-limb near-infrared spectroscopy (NIRS) monitoring as an adjunct to standard hourly neurovascular assessment (NVA) in patients receiving intra-aortic balloon pump (IABP) support, and to characterize the relationship between regional oxygen saturation (rSO₂) and in-hospital mortality.
DESIGN: Prospective observational cohort study.
SETTING: Cardiac care unit of a tertiary cardiac center (Tan Tock Seng Hospital, Singapore).
PARTICIPANTS: Fifty consecutive adult patients receiving IABP support via femoral arterial access.
INTERVENTIONS: Continuous bilateral lower-limb rSO₂ monitoring using NIRS was performed throughout IABP support, alongside standardized hourly NVA of both limbs (capillary refill time, skin color, temperature, pulse quality, and Doppler signal).
MEASUREMENTS AND MAIN RESULTS: Right femoral access was used in 94% of patients (47 of 50). Minimum contralateral (left) rSO₂ was significantly lower in nonsurvivors than survivors (29.3% ± 17.6% v 43.3% ± 14.4%, p = 0.024), with a directionally similar but nonsignificant trend on the ipsilateral (right) side (p = 0.083). Regional oxygen saturation correlated moderately with capillary refill time (Spearman rank correlation [rs] ≈ 0.50) and pulse quality (rs ≈ 0.38) bilaterally but not with temperature change, which deteriorated in >92% of limbs. Low rSO₂ (<40%) in either limb was associated with a nonsignificant 3.16-fold increase in mortality odds (95% confidence interval, 0.55-18.11; p = 0.197). No patient developed acute limb ischemia. Sepsis (odds ratio [OR], 13.0) and renal replacement therapy (OR, 7.1) were the only statistically significant predictors of mortality.
CONCLUSIONS: Continuous bilateral lower-limb rSO₂ monitoring is feasible throughout IABP support and produces a physiologically coherent signal that correlates moderately with objective NVA parameters and is lower in patients who do not survive to discharge. No limb ischemic events occurred; these findings are best regarded as feasibility and physiology data rather than evidence that continuous monitoring improves limb outcomes, and they warrant confirmation in a larger, multicenter study.
DESIGN: Prospective observational cohort study.
SETTING: Cardiac care unit of a tertiary cardiac center (Tan Tock Seng Hospital, Singapore).
PARTICIPANTS: Fifty consecutive adult patients receiving IABP support via femoral arterial access.
INTERVENTIONS: Continuous bilateral lower-limb rSO₂ monitoring using NIRS was performed throughout IABP support, alongside standardized hourly NVA of both limbs (capillary refill time, skin color, temperature, pulse quality, and Doppler signal).
MEASUREMENTS AND MAIN RESULTS: Right femoral access was used in 94% of patients (47 of 50). Minimum contralateral (left) rSO₂ was significantly lower in nonsurvivors than survivors (29.3% ± 17.6% v 43.3% ± 14.4%, p = 0.024), with a directionally similar but nonsignificant trend on the ipsilateral (right) side (p = 0.083). Regional oxygen saturation correlated moderately with capillary refill time (Spearman rank correlation [rs] ≈ 0.50) and pulse quality (rs ≈ 0.38) bilaterally but not with temperature change, which deteriorated in >92% of limbs. Low rSO₂ (<40%) in either limb was associated with a nonsignificant 3.16-fold increase in mortality odds (95% confidence interval, 0.55-18.11; p = 0.197). No patient developed acute limb ischemia. Sepsis (odds ratio [OR], 13.0) and renal replacement therapy (OR, 7.1) were the only statistically significant predictors of mortality.
CONCLUSIONS: Continuous bilateral lower-limb rSO₂ monitoring is feasible throughout IABP support and produces a physiologically coherent signal that correlates moderately with objective NVA parameters and is lower in patients who do not survive to discharge. No limb ischemic events occurred; these findings are best regarded as feasibility and physiology data rather than evidence that continuous monitoring improves limb outcomes, and they warrant confirmation in a larger, multicenter study.