Kusumastuti Neurinda Permata, Ontoseno Teddy, Endaryanto Anang
Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia.
Departement of Child Health, Dr. Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia.
Open Access Emerg Med. 2022 Mar 30;14:123-131. doi: 10.2147/OAEM.S357320. eCollection 2022.
Shock is a life-threatening syndrome in which tissue perfusion and oxygen delivery are inadequate. Near-infrared spectroscopy (NIRS) has been suggested as a noninvasive tool for monitoring and detecting the state of inadequate tissue perfusion. Renal and mesenteric oximetry show decreased cardiac output earlier than systemic or global parameters of tissue oxygenation or cerebral oximetry. However, until now there has been no study on the validity of regional renal oxygen saturation (rRSO) by NIRS for diagnosing shock in children.
To analyze the validity of rRSO by NIRS to diagnose shock in children.
This cross-sectional study was conducted in critically ill children (aged 1 month-18 years) who were admitted to the pediatric intensive care unit (PICU), from September to November 2020, consecutively. Patients were classified into two groups: shock and non-shock. The diagnosis of shock is based on clinical criteria (tachycardia, sign of hypoperfusion and decrease systolic blood pressure <P5 according to age). Measurement of rRSO by NIRS was performed by the doctor in charge when the patient came to PICU. The baseline rRSO value (%) made a receiver operating characteristic (ROC) curve and was used to find the optimal cut-off value and calculated sensitivity and specificity.
We enrolled 20 critically ill patients. The baseline rRSO in the shock (n=10) and non-shock (n=10) groups were, 44.00±4.95 vs 78.70±4.52 (p 0.003). The optimal cutoff value of the baseline rRSO to predict shock is less than 58.5% with area under the curve (AUC) value is 94.4% (95% CI of 84.4-100%), p 0.001, sensitivity 90% and specificity 90% in critically ill children.
The rRSO value by NIRS can differentiate between shock and non-shock in critically ill patients accurately.
休克是一种危及生命的综合征，其中组织灌注和氧输送不足。近红外光谱（NIRS）已被建议作为一种监测和检测组织灌注不足状态的非侵入性工具。肾脏和肠系膜血氧饱和度比全身或整体组织氧合参数或脑血氧饱和度更早显示心输出量下降。然而，迄今为止，尚无关于通过NIRS测量的局部肾脏氧饱和度（rRSO）用于诊断儿童休克有效性的研究。
分析通过NIRS测量的rRSO用于诊断儿童休克的有效性。
这项横断面研究于2020年9月至11月连续纳入入住儿科重症监护病房（PICU）的危重症儿童（年龄1个月至18岁）。患者分为两组：休克组和非休克组。休克的诊断基于临床标准（心动过速、低灌注体征以及根据年龄收缩压下降<P5）。患者入住PICU时，由主管医生通过NIRS测量rRSO。绘制基线rRSO值（%）的受试者工作特征（ROC）曲线，用于确定最佳截断值，并计算敏感性和特异性。
我们纳入了20例危重症患者。休克组（n = 10）和非休克组（n = 10）的基线rRSO分别为44.00±4.95和78.70±4.52（p<0.003）。预测休克的基线rRSO最佳截断值小于58.5%，曲线下面积（AUC）值为94.4%（95%CI为84.4 - 100%），p<0.001，在危重症儿童中敏感性为90%，特异性为90%。
通过NIRS测量的rRSO值能够准确区分危重症患者的休克和非休克状态。
