All authors: Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
Pediatr Crit Care Med. 2018 May;19(5):433-441. doi: 10.1097/PCC.0000000000001495.
To assess whether near-infrared cerebral tissue oxygen saturation, measured with the FORESIGHT cerebral oximeter (CAS Medical Systems, Branford, CT) predicts PICU length of stay, duration of invasive mechanical ventilation, and mortality in critically ill children after pediatric cardiac surgery.
Single-center prospective, observational study.
Twelve-bed PICU of a tertiary academic hospital.
Critically ill children and infants with congenital heart disease, younger than 12 years old, admitted to the PICU between October 2012 and November 2015. Children were monitored with the FORESIGHT cerebral oximeter from PICU admission until they were weaned off mechanical ventilation. Clinicians were blinded to cerebral tissue oxygen saturation data.
None.
Primary outcome was the predictive value of the first 24 hours of postoperative cerebral tissue oxygen saturation for duration of PICU stay (median [95% CI], 4 d [3-8 d]) and duration of mechanical ventilation (median [95% CI], 111.3 hr (69.3-190.4 hr]). We calculated predictors on the first 24 hours of cerebral tissue oxygen saturation monitoring. The association of each individual cerebral tissue oxygen saturation predictor and of a combination of predictors were assessed using univariable and multivariable bootstrap analyses, adjusting for age, weight, gender, Pediatric Index of Mortality 2, Risk Adjustment in Congenital Heart Surgery 1, cyanotic heart defect, and time prior to cerebral tissue oxygen saturation monitoring. The most important risk factors associated with worst outcomes were an increased SD of a smoothed cerebral tissue oxygen saturation signal and an elevated cerebral tissue oxygen saturation desaturation score.
Increased SD of a smoothed cerebral tissue oxygen saturation signal and increased depth and duration of desaturation below the 50% saturation threshold were associated with longer PICU and hospital stays and with longer duration of mechanical ventilation after pediatric cardiac surgery.
评估使用 FORESIGHT 脑氧饱和度仪（CAS Medical Systems，Branford，CT）测量的近红外脑组织氧饱和度是否可预测儿科心脏手术后危重症儿童重症监护病房（PICU）的住院时间、有创机械通气时间和死亡率。
单中心前瞻性观察性研究。
三级学术医院的 12 床 PICU。
2012 年 10 月至 2015 年 11 月期间，因先天性心脏病入住 PICU 的危重症儿童和婴儿，年龄小于 12 岁。从 PICU 入院开始，患儿接受 FORESIGHT 脑氧饱和度仪监测，直至他们脱离机械通气。临床医生对脑氧饱和度数据不知情。
无。
主要结局是术后 24 小时内脑组织氧饱和度对 PICU 住院时间（中位数[95%CI]，4 d[3-8 d]）和机械通气时间（中位数[95%CI]，111.3 小时[69.3-190.4 小时]）的预测值。我们在脑氧饱和度监测的前 24 小时计算了预测因子。使用单变量和多变量自举分析评估每个单独的脑氧饱和度预测因子和预测因子组合的相关性，调整因素包括年龄、体重、性别、儿科死亡率 2 评分、先天性心脏病手术风险调整 1 评分、紫绀型心脏缺陷和脑氧饱和度监测前的时间。与最差结果相关的最重要的危险因素是平滑脑氧饱和度信号的标准差增加和脑氧饱和度降低评分升高。
平滑脑氧饱和度信号的标准差增加以及饱和度降低 50%阈值的深度和持续时间增加与儿科心脏手术后 PICU 和住院时间延长以及机械通气时间延长相关。
