Cerebral regional oxygen saturation monitoring in pediatric malfunctioning shunt patients - 12/02/13
, Chuan Zhou, PhD c, Cristina Estrada, MD a, Patrick C. Drayna, MD a, Matthew R. Locklair, MD a, Renee Miller, RN, MSN a, Matthew Pearson, MD b, Noel Tulipan, MD b, Donald H. Arnold, MD, MPH aAbstract |
Background |
Shunt malfunction produces increased intracranial pressure causing decreased cerebral regional perfusion and tissue O2sat. Cerebral regional oxygen saturation (rSO2) by near-infrared spectroscopy represents tissue perfusion and oxygen saturation. Cerebral rSO2 is used to detect cerebral ischemia in pediatric clinical settings.
Objective |
The objective of the study was to determine the reliability of cerebral rSO2 in pediatric malfunctioning shunt.
Methods |
A prospective observational study of pediatric patients presented to the pediatric emergency department was conducted. Confirmed malfunctioning shunt subjects had cerebral rSO2 monitoring.
Results |
A total of 131 malfunctioning shunt subjects had cerebral rSO2 monitoring. Patient's central trend and intrasubject variability of cerebral rSO2 readings for left and right probe and malfunction sites (n = 131) are as follows:
VariableOverall, mean (SD)Distal, mean (SD)Proximal, mean (SD)PLeft probe trend69.1 (10.7)67.7 (9.81)70.0 (11.17).23Right probe trend71.3 (9.6)70.5 (8.13)71.8 (10.40).42Left probe variability3.57 (2.04)4.72 (2.55)2.88 (1.24)<.001Right probe variability3.46 (1.95)3.77 (2.20)3.28 (1.77).19
|
Intrasubject left and right rSO2 Pearson correlation was −0.46 to 0.98 (mean ± SD, 0.35 ± 0.34; median, 0.34; interquartile range, 0.06-0.61). The correlation coefficients of 99 subjects between left and right rSO2 was significantly different (P < .001), suggesting that intrasubjects' left and right rSO2 are highly correlated. Sample mean difference between left and right rSO2 were −1.7% (95% confidence interval [CI], −1.8 to −1.6; P < .001) supporting overall left lower than right. Intraclass correlation for left rSO2 was 87.4% (95% CI, 87.2%-87.6%), and that for right rSO2 was 83.8% (95% CI, 83.8%-84%), showing intersubject differences accounting for the variation, and relative to intersubject variation, intrasubjects readings are consistent. Intrasubjects, left and right rSO2 highly correlate and are asymmetrical. Left and right rSO2 are consistent in intrasubject with large rSO2 variations in trend and variability across subjects.
Conclusion |
This study demonstrates reliable cerebral rSO2 readings in subjects with malfunctioning shunts, with asymmetrical cerebral rSO2 hemispheric dynamics within subjects.
Le texte complet de cet article est disponible en PDF.Plan
| ☆ | Financial support: Internal funding support was provided by the Vanderbilt Institute for Clinical and Translational Research. Somanetics Corporation provided near-infrared machines and a limited number of near-infrared spectroscopy probes used in the study. Company representatives otherwise had no input into the design, execution, data analysis, or preparation of this manuscript. |
| ☆☆ | The authors have no conflicts of interest to disclose. |
| ★ | Thomas Abramo and Cristina Estrada wrote the first draft of the manuscript, and no honorarium, grant, or other form of payment was given to anyone to produce the manuscript. |
Vol 31 - N° 2
P. 365-374 - février 2013 Retour au numéro
Article précédent
- Identifying patients with cellulitis who are likely to require inpatient admission after a stay in an ED observation unit
- Kathryn A. Volz, Louisa Canham, Emily Kaplan, Leon D. Sanchez, Nathan I. Shapiro, Shamai A. Grossman
- The role of autonomic nervous system function in hypothermia-mediated sepsis protection
- Yun-Te Chang, Shue-Ren Wann, Jung-Shun Tsai, Chih-Hsiang Kao, Po-Tsang Lee, Neng-Chyan Huang, Cheng-Chang Yen, Mu-Shun Huang, Hong-Tai Chang
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?