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

Abstract

Intraabdominal hypertension is a common clinical condition with high mortality and morbidity in pediatric intensive care units. The aim of this study was to test the feasibility of regional tissue oxygenation (rSO 2) measurement using nearinfrared spectroscopy and to assess the correlation between rSO 2 and perfusion markers of intraabdominal hypertension in high-risk pediatric patients. Materials and methods: In this prospective observational cohort study in a tertiary pediatric intensive care unit in Çukurova University Faculty of Medicine, a total of 31 patients who were admitted between May 2017 and May 2018 with a risk of intraabdominal hypertension were included. Mesenteric and renal rSO 2 measurements were taken and correlations with other tissue perfusion markers including mean arterial pressure, pH, lactate, intraabdominal pressure, abdominal perfusion pressure, mixed venous oxygen saturation, vasoactive inotropic score were assessed. Intraabdominal pressure was measured as ≥10 mmHg in 15 patients (48.3%) and these patients were defined as the group with intraabdominal hypertension. Results: In the group with intraabdominal hypertension, mixed venous oxygen saturation was lower (P = 0.024), vasoactive inotropic score was higher (P = 0.024) and the mean abdominal perfusion pressure value was lower (P = 0.014). In the ROC analysis, the mesenteric rSO 2 measurement was the best parameter to predict intraabdominal hypertension with area under the curve of 0.812 (P = 0.003) 95% CI [0.652-0.973]. Conclusion: Monitoring of mesenteric rSO 2 is feasible in patients at risk for intraabdominal hypertension. Moreover, both mesenteric regional oxygen and perfusion markers may be used to identify pediatric patients at risk for intraabdominal hypertension.

Intra-Abdominal Hypertension and Compartment Syndrome after Pediatric Liver Transplantation: Incidence, Risk Factors and Outcome

“…However, we could not find any association between changes in microcirculation (including NIRS) and the presence of IAH or ACS. This is in contrast to other studies outside the pLT setting [ 42 , 43 ] and the results of our own unpublished studies for patients who had not undergone pLT. In pLT, this could be explained by the extraordinary situation of a denervated liver graft, in combination with hyperdynamic circulation, due to cirrhosis before pLT, leading to an increased total liver blood flow after pLT [ 44 ].…”