Cerebral oxygen saturation monitoring in pediatric altered mental status patients

Assessing the Impact of 3% Hypertonic Saline Hyperosmolar Therapy on Intubated Children With Isolated Traumatic Brain Injury by Cerebral Oximetry in a Pediatric Emergency Setting

“…7,[10][11][12]15,16,[24][25][26][27][28][29][30] For these epidural and subdural hematomas, whether hemispheric or bihemispheric, their pre-3% HTS and post-3% HTS infusion differences in r c SO 2 and CBVI readings demonstrated the significance of the concomitant effect of increased ICP on the contralateral cerebral physiology. 7,[10][11][12]15,16,[26][27][28][29][30] In the subdural compared with the epidural hematoma patients, the subdural patients had significantly lower ipsilateral and contralateral r c SO 2 and CBVI readings than did the epidural hematoma patients, and the subdural hematoma patients' contralateral hemisphere was more responsive to the 3% HTS infusion effect. 7,[10][11][12]15,16,[26][27][28][29][30] The lower contralateral r c SO 2 and CBVI readings could be the result of the initial trauma-induced intraparenchymal bleeding or expanding hematoma with hemorrhagic site expansion and increased ICP as an indirect effect causing increased pressure on the contralateral cerebral tissue, thus decreasing contralateral cerebral perfusion, oxygen delivery, and metabolism.…”

“…Because interhemispheric discordance r c SO 2 > 10 has been shown to have a strong correlation with abnormal hemispheric cerebral pathophysiology and clinical significance, conversely, a narrowing of this discordance difference would indicate an improvement in the abnormal hemispheric cerebral physiology. [16][17][18][19] With this premise, a detailed interhemispheric discordance r c SO 2 > 10 with CBVI differences in correlation with 3% HTS infusion times is presented in Tables 5 and 6; Table 9, Supplementary Digital Content 5, http://links.lww.com/PEC/A531 and Table 10, Supplementary Digital Content 6, http://links.lww.com/PEC/A536). A total of 125 patients had interhemispheric discordance r c SO 2 > 10 and received 3% HTS infusions.…”

“…7,[10][11][12][15][16][17][18][19][20][25][26][27][28][29][30] Significant simultaneously improved CBVI readings substantiated that the 3% HTS infusion effect correlated with hemispheric r c SO 2 readings changes. 7,12,[15][16][17][18][19][20][25][26][27][28][29][30] These CBVI changes demonstrated that the 3% HTS-induced changes in hemispheric r c SO 2 readings were reflective of 3% HTS inducing an improved regional cerebral tissue and bihemispheric perfusion similar to the invasive 3% HTS TBI studies. 7,12,[15][16][17][18][19][20][25][26][27][28][29][30] Because of the uncertainty of the isolated TBI injury time event, time from injury to medical attention, precise injury mechanism, and other trauma-related causation, further cerebral oximetry with CBVI or hemoglobin index investigation is warranted.…”

Neurocritical care monitoring of encephalopathic children with acute liver failure: A systematic review

“…Asymmetrical or extreme values in children attending the emergency department without a history of trauma have been found to correlate with evidence of intracranial hemorrhage on head computed tomography. 65,66 This bimodal distribution may explain the conflicting results of an earlier study, which failed to find a general association between rSO 2 and ICP in critically ill pediatric patients, albeit in a small sample. 67 In adults undergoing liver transplantation, NIRS has been shown to co-vary with determinants of cerebral oxygen delivery, namely hemoglobin, cardiac output, arterial partial pressure of carbon dioxide, and pH.…”

“…Measurements are typically taken continuously. Asymmetrical or extreme values in children attending the emergency department without a history of trauma have been found to correlate with evidence of intracranial hemorrhage on head computed tomography …”