Significant Correlation between Regional Tissue Oxygen Saturation and Vital Signs of Critically Ill Infants

Abstract

BackgroundNear-infrared spectroscopy (NIRS) has been used to non-invasively measure specific tissue oxygen saturation (StO2) continuously. Cerebral autoregulation status can be derived from NIRS and arterial blood pressure. The relationship of both cerebral and somatic StO2, fractional tissue oxygen extraction (FTOE), and cerebro-splanchnic oxygenation ratio (CSOR) with measured vital sign parameters for Neonatal Intensive Care Unit (NICU) patients has not been well studied.ObjectiveThe aims of this study are to determine if significant relationships of brain and somatic StO2, brain and somatic FTOE, and CSOR parameters with vital signs for neonates exist and assess relationship between pressure passivity index, cerebral autoregulation, and mean blood pressure (MBP).Design/methodsNeonates weighing < 5 kg, preferentially with an arterial catheter, were enrolled in the study. FORE-SIGHT Elite (CASMedical Systems, Inc., Branford, CT, USA) cerebral and somatic NIRS sensors were placed over the abdominal right upper quadrant and right frontal-temporal area of the forehead for 24 h. Vital signs including arterial MBP were recorded simultaneously from the patients’ bedside monitor. Data were averaged into 60 s windows and analyzed using linear regression. Results were stratified by gestational age (GA), birth weight (BW), and presence of brain abnormality.ResultsData were obtained from 27 subjects (GA 22.2–42 weeks). Two subjects did not have an arterial line, thus they were not included in the MBP measurements. There were ~28,000–31,000 paired data points per comparison. Significant positive and negative correlations (p value < 0.0001) were noted between NIRS parameters and vital signs. When stratified by BW, there was a positive correlation between brain StO2 (StO2B) and MBP in the <1,500 g BW group (r = 0.193) and a negative correlation in >1,500 g group (r = 0.057). Brain and somatic FTOE in <1,500 g BW revealed a negative correlation with MBP (r = 0.172 and r = 0.086, respectively). In patients with an abnormal brain scan, a positive correlation was noted between StO2B and MBP (r = 0.354), and a negative correlation was noted between FTOE-B and MBP (r = 0.305). Generated pressure passive index plots suggested good cerebral autoregulation at low normal MBP ranges for lower weight and GA subjects.ConclusionThere is a significant correlation between cerebral and somatic StO2 and FTOE with measured vital sign parameters in NICU patients.

Nutritional Practice-Related Alteration of Mesenteric Tissue Oxygenation in Fully Enteral-Fed Very and Extremely Preterm Neonates

“…Like the study by Poets et al [30], we too recorded systemic desaturation during bottle feeding, which did not affect the degree of the mesenteric tissue oxygenation and extraction and did not extend to the postprandial stage. The study by Massa-Buck et al [31] supports our findings, presenting a negative correlation of RR with oxygenation in the cerebral and somatic tissue in neonates born at 22 to 42 weeks of gestation. Some reports discuss the role of MOM, showing no impact of a 20-minute bolus feed with MOM but a persistent reduction of mesenteric tissue oxygenation in very preterm infants fed with the preterm formula [32].…”

Cerebral regional tissue Oxygen Saturation to Guide Oxygen Delivery in preterm neonates during immediate transition after birth (COSGOD III): multicentre randomised phase 3 clinical trial

“…Interventions in the present trial were therefore limited to oxygen titration, respiratory support, or intravenous fluids, or a combination of these factors. Changes in cardiovascular variables, including arterial blood pressure and cardiac output have been associated with changes in cerebral oxygenation during immediate transition91024 and have been described as predictors of cerebral injury, including intraventricular haemorrhage and cystic periventricular leukomalacia 252627. In the present trial, significantly more neonates in the near infrared spectroscopy group than control group received intravenous fluids (table 2), in part indicated by crSO 2 monitoring to improve cardio-circulation and cerebral perfusion.…”

“…Changes in cardiovascular variables, including arterial blood pressure and cardiac output have been associated with changes in cerebral oxygenation during immediate transition 9 10 24 and have been described as predictors of cerebral injury, including intraventricular haemorrhage and cystic periventricular leukomalacia. [25][26][27] In the present trial, significantly more neonates in the near infrared spectroscopy group than control group received intravenous fluids (table 2), in part indicated by crSO 2 monitoring to improve cardio-circulation and cerebral perfusion. Furthermore, a trend to a higher rate of mechanical ventilation was observed after resuscitation during the first day after birth in the near infrared spectroscopy group.…”

Prophylactic measures to prevent cerebral oxygen desaturation events in elective beach-chair position shoulder surgeries: a systematic review and meta-analysis

“…Thus, PPMs were unable to achieve the ultimate therapeutic benefit, despite maintaining MAP. The association of episodic decrease in MAP with the incidence of cerebral desaturation and its direct correlation with cerebral oximetry values remain unconfirmed [ 36 , 37 ]. Several studies have demonstrated no direct correlation between blood pressure and cerebral (de)saturation values ( Supplementary Material 5 ) [ 13 , 38 - 43 ].…”