Cerebral regional oxygen saturation monitoring in pediatric malfunctioning shunt patients

Cerebral Tissue Oxygen Saturation Measurements in Perinatal Asphyxia Cases Treated with Therapeutic Hypothermia

Cerebral tissue oxygen saturation (CrSO2) measured with near-infrared spectroscopy (NIRS) technology has recently become the subject of several research studies. The aim of this study was to investigate the diagnostic value of CrSO2 measurements in perinatal asphyxia (PA) cases. The study included a patient group of 42 PA cases, who were to be applied with therapeutic hypothermia (TH), and a control group of 42 healthy term newborns. PA cases were determined as moderate or severe encephalopathy (Sarnat score stage II or III) in clinical evaluation. In both groups, left (CrSO2L) and right (CrSO2R) NIRS measurements were taken for 10 minutes on the scalp. The arithmetic mean value of measurements was calculated and compared. The mean measurements were CrSO2R 67.38 ± 9.39 and CrSO2L 66.73 ± 7.76 in the patient group, and CrSO2R 80.28 ± 8.04 and CrSO2L 79.14 ± 8.49 in the control group. The mean CrSO2R and CrSO2L measurements of the patient group were statistically significantly lower than those of the control group (p < 0.001). In the Pearson correlation analysis, a significant correlation was determined in the patient group between cord blood gas pH and CrSO2R (r: 0.539, p < 0.001) and CrSO2L (r: 0.54, p < 0.001). For a cutoff value of CrSO2L ≤ 72%, the positive predictive value was 80 and the negative predictive value was 84.6. For a cutoff value of CrSO2R ≤ 74%, the positive predictive value was 79.5 and the negative predictive value was 82.5. Low CrSO2 measurements obtained with the NIRS method in PA cases to be applied with TH together with cord blood gas parameters can be considered a helpful parameter in diagnosis.

Comparison of Bilateral Cerebro-Renal Tissue Oxygenations in Healthy Children

OBJECTIVE

To investigate right and left cerebral tissue (ctSO₂) and renal tissue oxygenations (rtSO₂) in otherwise healthy children.

METHODS

In this observational cross-sectional study, one hundred children seen as outpatients for well child care or common non-critical complaints, were included. Bilateral ctSO₂ and rtSO₂ were recorded simultaneously with INVOS™ 5100 device.

RESULTS

The median age was 6.7 y (IQR 3-10.4) and median weight was 21 kg (IQR 13-33). Right and left sided ctSO₂ and rtSO₂ values were 78.7% ± 6.0% and 79.1% ± 5.7%; 81.5% ± 9.4% and 81.4% ± 9.5% respectively. There were no differences in right and left cerebral and renal near infrared spectroscopy (NIRS) values, and no age centered lateralization effect. Renal measurements were higher than cerebral counterparts in 63% of the children. Interaction between age and regional oxygenation was significant. For both sides, renal oxygenation was higher than that of cerebrum in older children, whereas the opposite held true with younger age.

CONCLUSIONS

There are no right and left side differences in ctSO₂ and rtSO₂ values in otherwise healthy children. On the other hand, there seem to be differences between cerebral and renal regions with a significant age effect. Acknowledging its limitations, this study sheds light on laterality and cranial and renal NIRS measurements in otherwise healthy children, and may contribute to the interpretation of NIRS data in critically ill patients.

Innovative Application of Cerebral rSO2 Monitoring During Shunt Tap in Pediatric Ventricular Malfunctioning Shunts

OBJECTIVE

This study aimed to determine the reliability and potential application of cerebral regional tissue oxygenation (rSO2) monitoring in malfunctioning ventricular shunts during tap.

METHODS

This is a prospective case series using convenience sample in subjects with confirmed malfunctioning shunt who had left and right cerebral rSO2 monitoring every 5 seconds before, during, and 1 hour after shunt tap.

RESULTS

Ninety-four subjects had cerebral rSO2 monitoring. Sixty-three subjects had proximal malfunctions, and 31 subjects had distal shunt malfunctions. The intrasubject's cerebral rSO2 trend and variability at pretap, during, and posttap times were highly correlated. Overall, the average rSO2 is lower in pretap as compared with posttap. Left cerebral rSO2 had lower means and larger SD as compared with right cerebral rSO2. Left pretap and posttap cerebral rSO2 variability was significantly associated with the location of shunt malfunction regardless of pretap, during, or posttap periods (P < 0.001), whereas right rSO2 variability was not predictive for malfunction location. Left cerebral rSO2 variability showed utility for identifying the location of malfunction with area under the receiver operating characteristic curve equal to 0.8.

CONCLUSIONS

Reliable cerebral rSO2 readings before, during, and after shunt tap were demonstrated. Left cerebral rSO2 changes from before to after shunt tap were more predictive for shunt malfunction location than right cerebral rSO2 changes. Observing cerebral rSO2 changes in relationship to shunt tap represents a potential surrogate in measuring cerebral pressures and blood flow changes after cerebral spinal fluid drainage. Significantly greater cerebral rSO2 changes occur for distal malfunction versus proximal malfunction after shunt tap, indicating its potential as an adjunct tool for detecting shunt malfunction type.

Cerebral oximetry with blood volume index in asystolic pediatric cerebrospinal fluid malfunctioning shunt patients

Pediatric cerebrospinal fluid shunt malfunctions can present with varying complaints. The primary cause is elevated intracranial pressure (ICP). Malfunctioning sites are the proximal or distal sites[1-4]. A rare presenting complaint is cardiac arrest. Immediate ICP reduction is the only reversible option for this type of cardiac arrest.