Cerebral regional oxygen saturation monitoring in pediatric malfunctioning shunt patients. Am J Emerg Med 2013 Feb;31(2):365-74
Date
11/17/2012Pubmed ID
23154102Pubmed Central ID
PMC3949442DOI
10.1016/j.ajem.2012.09.006Scopus ID
2-s2.0-84873658846 (requires institutional sign-in at Scopus site) 6 CitationsAbstract
BACKGROUND: Shunt malfunction produces increased intracranial pressure causing decreased cerebral regional perfusion and tissue O(2)sat. Cerebral regional oxygen saturation (rSO(2)) by near-infrared spectroscopy represents tissue perfusion and oxygen saturation. Cerebral rSO(2) is used to detect cerebral ischemia in pediatric clinical settings.
OBJECTIVE: The objective of the study was to determine the reliability of cerebral rSO(2) 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 rSO(2) monitoring.
RESULTS: A total of 131 malfunctioning shunt subjects had cerebral rSO(2) monitoring. Patient's central trend and intrasubject variability of cerebral rSO(2) readings for left and right probe and malfunction sites (n = 131) are as follows: Intrasubject left and right rSO(2) 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 rSO(2) was significantly different (P < .001), suggesting that intrasubjects' left and right rSO(2) are highly correlated. Sample mean difference between left and right rSO(2) were -1.7% (95% confidence interval [CI], -1.8 to -1.6; P < .001) supporting overall left lower than right. Intraclass correlation for left rSO(2) was 87.4% (95% CI, 87.2%-87.6%), and that for right rSO(2) 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 rSO(2) highly correlate and are asymmetrical. Left and right rSO(2) are consistent in intrasubject with large rSO(2) variations in trend and variability across subjects.
CONCLUSION: This study demonstrates reliable cerebral rSO(2) readings in subjects with malfunctioning shunts, with asymmetrical cerebral rSO(2) hemispheric dynamics within subjects.
Author List
Abramo TJ, Zhou C, Estrada C, Drayna PC, Locklair MR, Miller R, Pearson M, Tulipan N, Arnold DHAuthor
Patrick C. Drayna MD Associate Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentBiomarkers
Cerebrospinal Fluid Shunts
Cerebrum
Child
Child, Preschool
Emergency Service, Hospital
Equipment Failure
Feasibility Studies
Female
Hospitals, Pediatric
Humans
Hydrocephalus
Infant
Male
Monitoring, Physiologic
Oxygen
Prospective Studies
Reproducibility of Results
Spectroscopy, Near-Infrared
