Padmanabhan Pradeep, Berkenbosch John W, Lorenz Doug, Pierce Mary Clyde
Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Louisville, Louisville, KY, USA.
Ann Emerg Med. 2009 Aug;54(2):205-13. doi: 10.1016/j.annemergmed.2009.02.009. Epub 2009 Mar 13.
We evaluate the utility of near infrared spectroscopy monitoring and its correlation to conventional respiratory monitors during changes in cardiorespiratory characteristics during pediatric procedural sedation.
In this prospective observational study of 100 children, cerebral oxygenation (rSO(2)), pulse oximetry (SpO(2)), and end-tidal carbon dioxide (etco(2)) were monitored continuously. Values were manually recorded at least every 3 minutes from baseline until 30 minutes after sedative administration, resulting in 1,515 triplicate (simultaneous near infrared spectroscopy/etco(2)/SpO(2)) measurements. Correlations between conventional monitoring characteristics (SpO(2) and etco(2)) and rSO(2) were determined, with focus during adverse cardiorespiratory events.
Cerebral oxygenation remained normal in 1,483 of 1,515 measurements (97.9%). rSO(2) decreased significantly during 3 of 13 hypoxic events occurring in 13 patients and during 5 of 17 hypercarbic events occurring in 8 patients, with 15 measurements of greater than 20% decrease from baseline. Cerebral oxygenation increased transiently in 88% of children. During 31 cerebral desaturation recordings, 3 hypoxic recordings (9.3%, always in combination with hypercarbia) and 5 hypercarbic recordings (15.6%) were observed, whereas in 23 (74.2%), cardiorespiratory characteristics were unchanged. There was poor correlation between rSO(2) and both SpO(2) and etco(2), with correlation coefficients of 0.05 (95% confidence interval 0.04 to 0.07) and 0.01 (95% confidence interval -0.01 to 0.02), respectively.
Cerebral oxygenation as measured by near infrared spectroscopy demonstrated few significant negative changes during pediatric procedural sedation. Transient cardiorespiratory events seldom altered rSO(2), with hypercarbia having a greater effect than hypoxemia. However, cerebral desaturations frequently occurred without associated cardiorespiratory changes.
我们评估在儿科程序性镇静期间心肺特征变化时，近红外光谱监测的效用及其与传统呼吸监测的相关性。
在这项对100名儿童的前瞻性观察研究中，持续监测脑氧合（rSO₂）、脉搏血氧饱和度（SpO₂）和呼气末二氧化碳（etco₂）。从基线到给予镇静剂后30分钟，至少每3分钟手动记录一次数值，共得到1515组（同时进行近红外光谱/etco₂/SpO₂）测量值。确定传统监测特征（SpO₂和etco₂）与rSO₂之间的相关性，重点关注不良心肺事件期间的相关性。
1515次测量中有1483次（97.9%）脑氧合保持正常。在13名患者发生的13次低氧事件中的3次以及8名患者发生的17次高碳酸血症事件中的5次期间，rSO₂显著下降，有15次测量值较基线下降超过20%。88%的儿童脑氧合出现短暂升高。在31次脑氧饱和度降低记录中，观察到3次低氧记录（9.3%，总是与高碳酸血症同时出现）和5次高碳酸血症记录（15.6%），而在23次（74.2%）中，心肺特征未发生变化。rSO₂与SpO₂和etco₂之间的相关性均较差，相关系数分别为0.05（95%置信区间0.04至0.07）和0.01（95%置信区间 -0.01至0.02）。
通过近红外光谱测量的脑氧合在儿科程序性镇静期间显示出很少有显著的负面变化。短暂的心肺事件很少改变rSO₂，高碳酸血症的影响大于低氧血症。然而，脑氧饱和度降低经常在没有相关心肺变化的情况下发生。
