Low near infrared spectroscopic somatic oxygen saturation at admission is associated with need for lifesaving interventions among unplanned admissions to the pediatric intensive care unit

Abstract

To investigate the association between low near infrared spectroscopy (NIRS) somatic oxygen saturation (<70%) at admission and the need for lifesaving interventions (LSI) in the initial 24 h of a PICU admission. Retrospective chart review of all unplanned admissions to the pediatric intensive care unit (PICU) with NIRS somatic oxygen saturation data available within 4 h of admission, excluding admissions with a cardiac diagnosis. LSI data were collected for the first 24 h after admission. Hemodynamic parameters, laboratory values, illness severity scores and diagnoses were collected. Included PICU admissions were stratified by lowest NIRS value in the first 4 h after admission: low NIRS (<70%) and normal NIRS (≥70%) groups. Rate of LSI from 4 h to 24 h was compared between the two groups. Association of LSI with NIRS saturation and other clinical and laboratory parameters was measured by univariate and multivariate methods. We reviewed 411 consecutive unplanned admissions to the PICU of which 184 (44%) patients underwent NIRS monitoring. A higher proportion of patients who underwent somatic NIRS monitoring required LSIs compared to those without NIRS monitoring (36.4 vs 5.7% respectively, p < 0.0001). The proportion of patients who required LSI was higher in the group with low NIRS (<70%) within the first 4 h compared to those with normal NIRS (≥70%) (77.1 vs 22.1%, p < 0.0001). Fluid resuscitation, blood products and vasoactive medications were the most common LSIs. Multivariable modeling showed NIRS < 70% and heart rate > 2SD for age to be associated with LSIs. ROC curve analysis of the combination of NIRS < 70% and HR >2SD for age had an area under the curve of 0.79 with 78% sensitivity and 76% specificity for association with LSI. Compared to the normal NIRS group, the low NIRS group had higher mortality (10.4 vs 0.7%, p = 0.005) and longer median hospital length of stay (2.9 vs 1.6 days, p < 0.0001). Low somatic NIRS oxygen saturation (<70%) in the first 4 h of an unplanned PICU admission is associated with need for higher number of subsequent lifesaving interventions up to 24 h after admission. Noninvasive, continuous, somatic NIRS monitoring may identify children at high risk of medical instability.

Somatic regional oxygen saturation as an early marker of intra-abdominal hypertension in critically ill children: a pilot study

“…Decreased perfusion leads to increased oxygen extraction which results in lower rSO 2 measurements. In a retrospective study, Balakrishnan et al [18] evaluated low somatic NIRS values at pediatric intensive care admission in addition to other hemodynamic monitoring tools for critically ill children (serum lactate, severity of illness scores, heart rate, systolic blood pressure, arterial oxygen saturation, lactate level, acidosis) and need for life saving interventions (cardiopulmonary resuscitation, ECMO, invasive or noninvasive ventilation, emergent surgery, emergent dialysis, need for fluid resuscitation >40 mL/kg, blood product transfusion or vasoactive medications). They found a positive correlation between low somatic NIRS oxygen saturation and need for life saving interventions and a higher mortality rate in low NIRS group compared to normal NIRS group.…”

Near-Infrared Spectroscopy Assessments of Regional Cerebral Oxygen Saturation for the Prediction of Clinical Outcomes in Patients With Cardiac Arrest: A Review of Clinical Impact, Evolution, and Future Directions

“…Another study reported that NIRS monitoring can aid in assessing perfusion and guiding interventions during transport ( 78 ). Some authors have suggested that low NIRS readings highlight the need for additional lifesaving interventions such as fluid resuscitation and/or vasopressors ( 40 , 41 , 79 ). Therefore, NIRS monitoring may enable early recognition of re-arrest, especially in PEA, and poor cerebral circulation during EMS resuscitation protocol.…”

Journal of Clinical Monitoring and Computing 2017/2018 end of year summary: monitoring—and provocation—of the microcirculation and tissue oxygenation

“…This issue was assessed in this journal in February 2018 by Balakrishnan et al [14] in pediatric ICU patients with respect to the requirement for lifesaving interventions in the first 24 h following ICU admission. The use of such interventions, e.g.…”