Balakrishnan Binod, Dasgupta Mahua, Gajewski Kim, Hoffmann Raymond G, Simpson Pippa M, Havens Peter L, Hanson Sheila J
Section of Critical Care, Children's Hospital of Wisconsin, 9000 W Wisconsin Ave, Milwaukee, WI, 53226-4874, USA.
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA.
J Clin Monit Comput. 2018 Feb;32(1):89-96. doi: 10.1007/s10877-017-0007-1. Epub 2017 Mar 3.
To investigate the association between low near infrared spectroscopy (NIRS) somatic oxygen saturation (<70%) at admission and the need for lifesaving interventions (LSI) in the initial 24 h of a PICU admission. Retrospective chart review of all unplanned admissions to the pediatric intensive care unit (PICU) with NIRS somatic oxygen saturation data available within 4 h of admission, excluding admissions with a cardiac diagnosis. LSI data were collected for the first 24 h after admission. Hemodynamic parameters, laboratory values, illness severity scores and diagnoses were collected. Included PICU admissions were stratified by lowest NIRS value in the first 4 h after admission: low NIRS (<70%) and normal NIRS (≥70%) groups. Rate of LSI from 4 h to 24 h was compared between the two groups. Association of LSI with NIRS saturation and other clinical and laboratory parameters was measured by univariate and multivariate methods. We reviewed 411 consecutive unplanned admissions to the PICU of which 184 (44%) patients underwent NIRS monitoring. A higher proportion of patients who underwent somatic NIRS monitoring required LSIs compared to those without NIRS monitoring (36.4 vs 5.7% respectively, p < 0.0001). The proportion of patients who required LSI was higher in the group with low NIRS (<70%) within the first 4 h compared to those with normal NIRS (≥70%) (77.1 vs 22.1%, p < 0.0001). Fluid resuscitation, blood products and vasoactive medications were the most common LSIs. Multivariable modeling showed NIRS < 70% and heart rate > 2SD for age to be associated with LSIs. ROC curve analysis of the combination of NIRS < 70% and HR >2SD for age had an area under the curve of 0.79 with 78% sensitivity and 76% specificity for association with LSI. Compared to the normal NIRS group, the low NIRS group had higher mortality (10.4 vs 0.7%, p = 0.005) and longer median hospital length of stay (2.9 vs 1.6 days, p < 0.0001). Low somatic NIRS oxygen saturation (<70%) in the first 4 h of an unplanned PICU admission is associated with need for higher number of subsequent lifesaving interventions up to 24 h after admission. Noninvasive, continuous, somatic NIRS monitoring may identify children at high risk of medical instability.
目的是研究儿科重症监护病房（PICU）入院时低近红外光谱（NIRS）体氧饱和度（<70%）与入院最初24小时内进行挽救生命干预（LSI）需求之间的关联。对所有计划外入住儿科重症监护病房且入院后4小时内有NIRS体氧饱和度数据的患者进行回顾性病历审查，排除患有心脏疾病诊断的患者。收集入院后前24小时的LSI数据。收集血流动力学参数、实验室值、疾病严重程度评分和诊断信息。纳入的PICU入院患者按入院后前4小时的最低NIRS值分层：低NIRS（<70%）组和正常NIRS（≥70%）组。比较两组从4小时到24小时的LSI发生率。通过单因素和多因素方法测量LSI与NIRS饱和度以及其他临床和实验室参数之间的关联。我们回顾了411例连续计划外入住PICU的患者，其中184例（44%）患者接受了NIRS监测。与未进行NIRS监测的患者相比，接受体NIRS监测的患者中需要进行LSI的比例更高（分别为36.4%和5.7%，p<0.0001）。在入院后前4小时内，NIRS低（<70%）组中需要进行LSI的患者比例高于NIRS正常（≥70%）组（77.1%对22.1%，p<0.0001）。液体复苏、血液制品和血管活性药物是最常见的LSI。多变量模型显示NIRS<70%和年龄心率>2标准差与LSI相关。NIRS<70%和年龄心率>2标准差联合的ROC曲线分析的曲线下面积为0.79，与LSI关联的敏感性为78%，特异性为76%。与正常NIRS组相比，低NIRS组的死亡率更高（10.4%对0.7%，p=0.005），中位住院时间更长（2.9天对1.6天，p<0.0001）。计划外PICU入院后前4小时低体NIRS氧饱和度（<70%）与入院后24小时内后续需要更多挽救生命干预措施相关。无创、连续的体NIRS监测可能识别出医疗不稳定高风险儿童。
