173 Predictors of Outcome in Acute Meningococcal Infections

Abstract

We evaluated non-invasive transcutaneous p u l s e oximetry (NIPO) i n 28 p e d i a t r i c p t s , ages 3 mos.-11 y r s , wts. 2.5-36 kgs. w i t h moderate t o s e v e r e c y a m t i c c o n g e n i t a l h e a r t d i s e a s e (CyCHD) during c a r d i a c c a t h e t e r i z a t i o n , i n t r a -o p e r a t i v e l y during closed h e a r t surgery and i n t h e ICU. 02 s a t u r a t i o n s ( s a t s ) from (NIPO), using the Nellcor P u l s e Oximeter 1100, were compared w i t h simultaneously obtained a r t e r i a l blood samples analyzed by t h e IL282 CO-oximeter. Comparison of 94 d a t a p a i r s showed excell e n t agreement between t h e 2 methods over a wide range of 02 s a t s (38-90%) with r=.93 SEE 3.62. Even i n t h e low range of 02 (38-75%) 34 d a t a p a i r s showed good agreement between the 2 methods, r=.81 SEE 5.14. The accuracy of t h e NIPO was independent of t h e p t s wt., h e a r t r a t e o r blood pressure. I n 3 p t s , t h e s h a r p decrease i n 02 s a t s allowed t h e diagnosis of hypoxic t e t r a l o g y s p e l l s before t h e o n s e t of any c l i n i c a l findings. Intra-operatively t h e use of NIPO confirmed the patency of aorto-pulmonary shunts and changes i n a r t e r i a l 02 s a t s accompanying g e n e r a l anesthesia. Post o p e r a t i v e l y i n t h e ICU, NIPO allowed a c c u r a t e management of v e n t i l a t o r y support during varying hernodynamic s t a t e s . Thus, i n c h i l d r e n with CyCHD, NIPO i s a n a c c u r a t e method of determining O2 s a t s and c o n t r i b u t e s to improved management during c a r d i a c c a t h e t e r i z a t i o n , h e a r t surgery and recovery i n the ICU. This study e s t a b l i s h e s a new a p p l i c a t i o n of NIPO i n t h e c a r e of c h i l d r e n w i t h CyCHD. Normative v a l u e s of i n t r a -a r t e r i a l blood p r e s s u r e (ABP) i n newborns were obtained using a s t r a i n gauge connected t o an umbilical a r t e r y c a t h e t e r without i n t e r p o s i t i o n of continuous infusion devices. Currently v a l u e s on which treatment d e c i s i o n s a r e based, a r e obtained while systems f o r continuous i n f u s i o n of f l u i d s -(intraflow-IF), even though ABP v a l u e s from t h e s e d i f f e r e n t techniques have n o t been compared. We evaluated 170 p a i r s of d i r e c t umbilical ABP measurements obtained, with and without I F systems, from 16 i n f a n t s , BW range 730-4790 gm, during t h e f i r s t week of l i f e . Mean s y s t o l i c blood p r e s s u r e s were 4 and d i a s t o l i c 4.2 mmHg lower while using I F systems than without (p<.001). The s i z e of t h e i n f a n t and t h e i n f u s i o n c a p a c i t y through t h e I F system i n f l u e n c e t h e magnitude of t h e observed d i f f e r e n c e s . The smaller t h e infant-with lower blood pressure-and t h e g r e a t e r t h e c a p a c i t y o f t h e I F system, t h e lower w i l l b e t h e ABP v a l u e s obtained. Under t h e s e conditions hypotension w i l ...