Department of Pediatrics, Renal Section, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA,
Department of Pediatrics, Renal Section, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
Blood Purif. 2020;49(6):665-669. doi: 10.1159/000508059. Epub 2020 Jul 8.
Noninvasive hematocrit monitoring (NIVHM) during pediatric hemodialysis (pedHD) provides data in real time regarding changes in hematocrit and blood volume and also provides venous oxygen saturations. The latter has been proposed to indicate changes in tissue oxygen consumption. It is not known how well NIVHM oxygen saturations (O2sat) approximate blood gas measured oximetry saturation (mO2sat) in the course of pedHD. We aimed to assess the validity and reliability of NIVHM O2sat compared to mO2sat.
This is a prospective study in 15 patients <21 years old with >90 days on hemodialysis (HD) without congenital heart disease. HD access was fistula (AVF) in 4 patients and tunneled catheters in the remainder. Pulse oximetry (spO2) was continuously monitored; mO2sat was measured via oximetry in a blood gas analyzer and NIVHM O2sat values collected at the start, middle, and end of HD treatment.
A total of 45 dyad measurements were obtained. NIVHM O2sat correlated well with mO2sat (R = 0.89, p < 0.0001); the same was seen at pre, mid, and post HD time points (R = 0.86-0.95, p < 0.001). NIVHM O2sat was lower than mO2sat; with catheter as access, the difference was 9.3 ± 8.6 (CI: 12.3-6.22, p < 0.0001) and with AVF was 2.1 ± 0.78 (CI: 2.6-1.7, p < 0.0001). Bland-Altman analysis demonstrated the difference but did not show any systematic bias. Continuous monitor of spO2 showed no hypoxia.
DISCUSSION/CONCLUSION: Intradialytic NIVHM O2sat correlates well with mO2sat but yield lower values. Future studies can include NIVHM O2sat changes as a surrogate for central venous O2 saturation changes and potentially yield useful information regarding tissue oxygen consumption in pedHD patients.
儿科血液透析（pedHD）期间的无创性红细胞压积监测（NIVHM）可实时提供红细胞压积和血容量变化的数据，还可提供静脉血氧饱和度。后者被提议用于指示组织耗氧量的变化。尚不清楚在 pedHD 过程中，NIVHM 氧饱和度（O2sat）与血气测量的血氧饱和度（mO2sat）的吻合程度。我们旨在评估 NIVHM O2sat 与 mO2sat 的相关性。
这是一项针对 15 名年龄<21 岁、血液透析时间>90 天且无先天性心脏病的患者的前瞻性研究。4 名患者使用动静脉瘘（AVF），其余患者使用隧道式导管。连续监测脉搏血氧饱和度（spO2）；通过血气分析仪中的血氧计测量 mO2sat，并在血液透析治疗开始、中间和结束时收集 NIVHM O2sat 值。
共获得 45 对双变量测量值。NIVHM O2sat 与 mO2sat 相关性良好（R = 0.89，p < 0.0001）；在血液透析前、中、后时间点也有相同的情况（R = 0.86-0.95，p < 0.001）。NIVHM O2sat 低于 mO2sat；导管作为通路时，差异为 9.3 ± 8.6（CI：12.3-6.22，p < 0.0001），动静脉瘘时差异为 2.1 ± 0.78（CI：2.6-1.7，p < 0.0001）。Bland-Altman 分析显示了差异，但没有显示任何系统偏差。连续监测 spO2 未显示缺氧。
讨论/结论：血液透析过程中的 NIVHM O2sat 与 mO2sat 相关性良好，但得出的数值较低。未来的研究可以将 NIVHM O2sat 变化作为中心静脉血氧饱和度变化的替代指标，并可能为 pedHD 患者的组织耗氧量提供有用信息。
