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

Abramo, Thomas J.; Zhou, Chuan; Estrada, Cristina; Meredith, Mark; Miller, Renee; Pearson, Matthew; Tulipan, Noel; Williams, Andrew

doi:10.1097/pec.0000000000000141

Cited by 8 publications

(46 citation statements)

References 23 publications

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“…Therefore, rcSO 2 does not provide an indicator of oxygen delivery and instead provides information regarding the balance between regional oxygen supply and demand (4). Recent studies have suggested that pediatric patients may benefit from rcSO 2 monitoring during surgery (5)(6)(7)(8)(9). The use of rcSO 2 is increasing, but the routine use of rcSO 2 as a standard-of-care monitor is still not recommended at present.…”

Section: Introductionmentioning

confidence: 99%

Comparing the response of pulse oximetry and regional cerebral oxygen saturation to hypoxia in preschool children

et al. 2019

Exp Ther Med

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Pulse oximetry and measurement of regional cerebral oxygen saturation (rcSO 2) are used to monitor peripheral and cerebral oxygenation, respectively. However, the response of rcSO 2 and pulse oxygen saturation (SpO 2) to hypoxia in preschool children has not been previously assessed. A total of 36 preschool patients who had undergone a tonsillectomy [age, 4-6 years, American Society of Anesthesiologists grade I or II] were screened and prospectively enrolled in the present study. Hemodynamics, including rcSO 2 , SpO 2 , non-invasive blood pressure, heart rate, electrocardiogram and capnography, were continuously monitored throughout the study. Following pre-oxygenation, pressure-controlled ventilation with 100% oxygen was administered through a mask with a flow rate of 6 l/min, under total intravenous anesthesia, and the end-tidal carbon dioxide partial pressure was maintained between 30 and 40 mmHg. Tracheal intubation was then performed and ventilation was paused until SpO 2 decreased to 90% or rcSO 2 decreased by >10% of the baseline level. The duration from pausing of mechanical ventilation to the start of the rcSO 2 decline was shorter than that of SpO 2 (80.2±23.6 sec vs. 124.4±20.5 sec; P<0.001). Subsequent to the recovery of ventilation, the duration from the starting point to the increasing point of the baseline of rcSO 2 was longer than that of SpO 2 (84.8±24.3 sec vs. 15.2±6.8 sec; P<0.001). From the point where mechanical ventilation was paused to when rcSO 2 /SpO 2 began to decrease, the rcSO 2 and SpO 2 values decreased and a significant correlation of them was observed (Pearson's correlation coefficient=0.317; P=0.027). From the time-point where mechanical ventilation was recovered to the time-point where rcSO 2 or SpO 2 began to increase, rcSO 2 and SpO 2 values decreased and a significant correlation of them was observed (Spearman's correlation coefficient= 0.489; P= 0.006). From the baseline to the minimum value, compared with the SpO 2 , the rcSO 2 declined at a decreased rate (9.7±0.5% vs. 5.3±2.7%; P<0.001). The present clinical trial was registered at http://www.chictr.org.cn on 14th March 2016 (registration no. ChiCTR-OOC-16008095).

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Section: Introductionmentioning

confidence: 99%

Comparing the response of pulse oximetry and regional cerebral oxygen saturation to hypoxia in preschool children

et al. 2019

Exp Ther Med

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“…This small, preliminary SCEDKA cerebral oximetry with 3% HTS infusion study demonstrated that initial bihemispheric r c SO 2 readings were greater than 90% respectively signifying initial bihemispheric altered cerebral physiology in comparison with Robert's nonhemispheric cerebral oximetry DKA study with SCEDKA r c SO 2 readings above 90%. 10,11 For the 3% HTS SCEDKA patients, their initial and pre-3% HTS infusion bihemispheric r c SO 2 readings were severely elevated (>90%) in comparison with non-SCEDKA DKA patients and correlated to the SCEDKA patients' altered altered mental status and lower GCS indicating clinically evident cerebral edema. In these patients with severe altered AMS and lower GCS, these severely elevated bihemispheric r c SO 2 readings indicated significant altered bilateral cerebral physiology in comparison with non-SCEDKA DKA patients.…”

Section: Discussionmentioning

confidence: 96%

“…[6][7][8][9][10][11] In this preliminary study, all SCEDKA patients had consistently high initial near infrared spectroscopy readings, post-3% HTS infusions a sharp decline in bihemispheric r c SO 2 readings and a short transient below 60% bihemispheric r c SO 2 readings, and then a rebound to normal bihemispheric r c SO 2 readings. [6][7][8][9][10][11][12][13][14][15][16][17][18] These bihemispheric r c SO 2 reading changes also correlated to the changes in GCS. From this study, it was demonstrated that there were no deleterious effects on the electrolytes or mental status from the 3% HTS infusions.…”

Section: Discussionmentioning

confidence: 98%

“…[8][9][10][11] In pediatric patients, the standard bihemispheric r c SO 2 baseline readings are 60% to 80%; a low r c SO 2 (<60%) or a high-value r c SO 2 (>80%) shows effects and signs of an increase in ICP and cerebral edema. [8][9][10][11] Very high cerebral r c SO 2 (>85) readings for pediatric patients associated with increased oxygenated Hgb in the sampling site, which is a result of regional, cerebral tissue venous stagnation with decreased oxygen metabolism and little oxygen extraction caused by increased ICP causing blood flow stagnation. [8][9][10][11] Cerebral oximetry monitoring has shown its functionality by detecting immediate cerebral physiology changes during therapeutic mechanical cerebral spinal fluid removal in patients with elevated ICP-induced altered bihemispheric cerebral physiology as demonstrated by a hemispheric r c SO 2 reading changes.…”

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confidence: 99%

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Bihemispheric Cerebral Oximetry Monitoring's Functionality in Suspected Cerebral Edema Diabetic Ketoacidosis With Therapeutic 3% Hyperosmolar Therapy in a Pediatric Emergency Department

Abramo¹,

Szlam

Hargrave³

et al. 2019

Pediatr Emer Care

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Background: Suspected cerebral edema diabetic ketoacidosis (SCEDKA) is more common than perceived with symptoms including altered mentation, headache with vomiting, depressed Glasgow coma scale (GCS), abnormal motor or verbal responses, combativeness, and neurological depression. Suspected cerebral edema diabetic ketoacidosis has been associated with initial diabetic ketoacidosis (DKA) presentation and at start of DKA therapy.Cerebral oximetry (bihemispheric regional cerebral oxygen saturation [r c SO 2 ] and cerebral blood volume index [CBVI]) can detect increased intracranial pressure (ICP)-induced altered bihemispheric cerebral physiology (r c SO 2 ) (

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“…Our results expand on previous studies of optical neuromonitoring in this population, which commonly relied on detection of diminished cerebral oxygenation using nearinfrared spectroscopy. [26][27][28][29][30] Whereas cerebral oxygenation has been associated with ventricular dilation 30 and has been demonstrated to improve after CSF diversion, [26][27][28][29] nearinfrared spectroscopy measurements have limited reproducibility and reliability. 31,32 FD-DOS uses a more quantitative measurement of StO 2 that accounts for tissue scattering.…”

Section: Discussionmentioning

confidence: 99%

Optical Detection of Intracranial Pressure and Perfusion Changes in Neonates With Hydrocephalus

Flanders

Lang

et al. 2021

The Journal of Pediatrics

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Objective To demonstrate that a novel noninvasive index of intracranial pressure (ICP) derived from diffuse optics-based techniques is associated with intracranial hypertension. Study designWe compared noninvasive and invasive ICP measurements in infants with hydrocephalus. Infants born term and preterm were eligible for inclusion if clinically determined to require cerebrospinal fluid (CSF) diversion. Ventricular size was assessed preoperatively via ultrasound measurement of the fronto-occipital (FOR) and frontotemporal (FTHR) horn ratios. Invasive ICP was obtained at the time of surgical intervention with a manometer. Intracranial hypertension was defined as invasive ICP ³15 mmHg. Diffuse optical measurements of cerebral perfusion, oxygen extraction, and noninvasive ICP were performed preoperatively, intraoperatively, and postoperatively. Optical and ultrasound measures were compared with invasive ICP measurements, and their change in values after CSF diversion were obtained. ResultsWe included 39 infants, 23 with intracranial hypertension. No group difference in ventricular size was found by FOR (P = .93) or FTHR (P = .76). Infants with intracranial hypertension had significantly higher noninvasive ICP (P = .02) and oxygen extraction fraction (OEF) (P = .01) compared with infants without intracranial hypertension. Increased cerebral blood flow (P = .005) and improved OEF (P < .001) after CSF diversion were observed only in infants with intracranial hypertension.Conclusions Noninvasive diffuse optical measures (including a noninvasive ICP index) were associated with intracranial hypertension. The findings suggest that impaired perfusion from intracranial hypertension was independent of ventricular size. Hemodynamic evidence of the benefits of CSF diversion was seen in infants with intracranial hypertension. Noninvasive optical techniques hold promise for aiding the assessment of CSF diversion timing.

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

Cited by 8 publications

References 23 publications

Comparing the response of pulse oximetry and regional cerebral oxygen saturation to hypoxia in preschool children

Comparing the response of pulse oximetry and regional cerebral oxygen saturation to hypoxia in preschool children

Bihemispheric Cerebral Oximetry Monitoring's Functionality in Suspected Cerebral Edema Diabetic Ketoacidosis With Therapeutic 3% Hyperosmolar Therapy in a Pediatric Emergency Department

Optical Detection of Intracranial Pressure and Perfusion Changes in Neonates With Hydrocephalus

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