Flechet Marine, Güiza Fabian, Scharlaeken Isabelle, Vlasselaers Dirk, Desmet Lars, Van den Berghe Greet, Meyfroidt Geert
All authors: Clinical Division and Laboratory of Intensive Care Medicine, Academic Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
Crit Care Explor. 2019 Dec 10;1(12):e0063. doi: 10.1097/CCE.0000000000000063. eCollection 2019 Dec.
Cerebral oximetry by near-infrared spectroscopy is used frequently in critically ill children but guidelines on its use for decision making in the PICU are lacking. We investigated cerebral near-infrared spectroscopy oximetry in its ability to predict severe acute kidney injury after pediatric cardiac surgery and assessed its additional predictive value to routinely collected data.
Prospective observational study. The cerebral oximeter was blinded to clinicians.
Twelve-bed tertiary PICU, University Hospitals Leuven, Belgium, between October 2012 and November 2015.
Critically ill children with congenital heart disease, younger than 12 years old, were monitored with cerebral near-infrared spectroscopy oximetry from PICU admission until they were successfully weaned off mechanical ventilation.
None.
The primary outcome was prediction of severe acute kidney injury 6 hours before its occurrence during the first week of intensive care. Near-infrared spectroscopy-derived predictors and routinely collected clinical data were compared and combined to assess added predictive value. Of the 156 children included in the analysis, 55 (35%) developed severe acute kidney injury. The most discriminant near-infrared spectroscopy-derived predictor was near-infrared spectroscopy variability (area under the receiver operating characteristic curve, 0.68; 95% CI, 0.67-0.68), but was outperformed by a clinical model including baseline serum creatinine, cyanotic cardiopathy pre-surgery, blood pressure, and heart frequency (area under the receiver operating characteristic curve, 0.75; 95% CI, 0.75-0.75; < 0.001). Combining clinical and near-infrared spectroscopy information improved model performance (area under the receiver operating characteristic curve, 0.79; 95% CI, 0.79-0.80; < 0.001).
After pediatric cardiac surgery, near-infrared spectroscopy variability combined with clinical information improved discrimination for acute kidney injury. Future studies are required to identify whether supplementary, timely clinical interventions at the bedside, based on near-infrared spectroscopy variability analysis, could improve outcome.
近红外光谱法进行脑氧饱和度测定在危重症儿童中经常使用，但在儿科重症监护病房（PICU）中缺乏关于其用于决策的指南。我们研究了脑近红外光谱法测定在预测小儿心脏手术后严重急性肾损伤方面的能力，并评估了其对常规收集数据的额外预测价值。
前瞻性观察性研究。脑氧饱和度测定仪对临床医生是盲法的。
2012年10月至2015年11月期间，比利时鲁汶大学医院拥有12张床位的三级PICU。
年龄小于12岁的患有先天性心脏病的危重症儿童，从入住PICU开始直至成功脱机均采用脑近红外光谱法进行监测。
无。
主要结局是预测重症监护第一周内严重急性肾损伤发生前6小时的情况。比较并结合近红外光谱法得出的预测指标和常规收集的临床数据，以评估额外的预测价值。纳入分析的156名儿童中，55名（35%）发生了严重急性肾损伤。近红外光谱法得出的最具鉴别力的预测指标是近红外光谱变异性（受试者工作特征曲线下面积，0.68；95%置信区间，0.67 - 0.68），但在包含基线血清肌酐、术前青紫型心脏病、血压和心率的临床模型面前表现较差（受试者工作特征曲线下面积，0.75；95%置信区间，0.75 - 0.75；<0.001）。将临床和近红外光谱信息相结合可提高模型性能（受试者工作特征曲线下面积，0.79；95%置信区间，0.79 - 0.80；<0.001）。
小儿心脏手术后，近红外光谱变异性与临床信息相结合可提高对急性肾损伤的鉴别能力。未来需要开展研究，以确定基于近红外光谱变异性分析在床边进行补充性、及时性的临床干预是否能改善预后。
