Sahni Rakesh
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Curr Opin Pediatr. 2017 Apr;29(2):141-148. doi: 10.1097/MOP.0000000000000459.
Standard hemodynamic monitoring such as heart rate and systemic blood pressure may only provide a crude estimation of organ perfusion during neonatal intensive care. Pulse oximetry monitoring allows for continuous noninvasive monitoring of hemoglobin oxygenation and thus provides estimation of end-organ oxygenation. This review aims to provide an overview of pulse oximetry and discuss its current and potential clinical use during neonatal intensive care.
Technological advances in continuous assessment of dynamic changes in systemic oxygenation with pulse oximetry during transition to extrauterine life and beyond provide additional details about physiological interactions among the key hemodynamic factors regulating systemic blood flow distribution along with the subtle changes that are frequently transient and undetectable with standard monitoring.
Noninvasive real-time continuous systemic oxygen monitoring has the potential to serve as biomarkers for early-organ dysfunction, to predict adverse short-term and long-term outcomes in critically ill neonates, and to optimize outcomes. Further studies are needed to establish values predicting adverse outcomes and to validate targeted interventions to normalize abnormal values to improve outcomes.
在新生儿重症监护期间，诸如心率和体循环血压等标准血流动力学监测可能仅能粗略估计器官灌注情况。脉搏血氧饱和度监测可对血红蛋白氧合进行连续无创监测，从而提供终末器官氧合情况的估计。本综述旨在概述脉搏血氧饱和度，并讨论其在新生儿重症监护期间的当前及潜在临床应用。
在向宫外生活过渡及之后，利用脉搏血氧饱和度对体循环氧合的动态变化进行连续评估的技术进步，提供了有关调节体循环血流分布的关键血流动力学因素之间生理相互作用的更多细节，以及标准监测经常无法检测到的细微且往往短暂的变化。
无创实时连续体循环氧监测有潜力作为早期器官功能障碍的生物标志物，预测危重新生儿的不良短期和长期结局，并优化结局。需要进一步研究来确定预测不良结局的数值，并验证使异常值正常化以改善结局的靶向干预措施。
