绝对近红外光谱与相对近红外光谱在儿科心脏患者中的应用比较。

Absolute Versus Relative Near-Infrared Spectroscopy in Pediatric Cardiac Patients.

机构信息

Division of Pediatric Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Division of Pediatric Cardiac Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

出版信息

Pediatr Crit Care Med. 2023 Mar 1;24(3):204-212. doi: 10.1097/PCC.0000000000003118. Epub 2022 Dec 13.

DOI:10.1097/PCC.0000000000003118

PMID:36729677

Abstract

OBJECTIVES

Near-infrared spectroscopy (NIRS) has been increasingly accepted as a noninvasive marker of regional tissue oxygenation despite concerns of imprecision and wide limits of agreement (LOA) with invasive oximetry. New generation absolute monitors may have improved accuracy compared with trend monitors. We sought to compare the concordance with invasive venous oximetry of a new generation absolute NIRS-oximeter (FORESIGHT ELITE; CASMED, Branford, CT) with a modern widely used trend monitor (INVOS 5100C; Medtronic, Minneapolis, MN).

DESIGN

Prospective single-center study.

SETTING

Tertiary pediatric heart center.

PATIENTS

Children undergoing elective cardiac catheterization under general anesthesia. Time-paired venous oximetry samples (jugular and renal) were compared with NIRS-derived oximetry by two monitors using regression and Bland-Altman analysis.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We enrolled 36 children (19 female, 10 cyanotic) with median age 4.1 years (25-75%, 2.5-7.8 yr) and weight 16.7 kg (12.3-29.1 kg). The absolute difference between NIRS-derived and invasive jugular oximetry was less than 10% in 67% of occasions for both monitors. Correlation was fair (Spearman rs = 0.40; p = 0.001) for the FORESIGHT ELITE and poor ( rs = 0.06; p = 0.71) for the INVOS 5100C. Bias and LOA were +6.7% (+22%, -9%) versus +1.3% (LOA = +24%, -21%), respectively. The absolute difference between NIRS-derived and invasive renal oximetry was less than 10% in 80% of occasions with moderate correlation ( rs = 0.57; p < 0.001) for the FORESIGHT ELITE and in 61% of occasions with moderate correlation ( rs = 0.58; p < 0.001) for the INVOS 5100C; bias and LOA were +3.6% (+19%, -12%) and -1.4 % (+27%, -30%), respectively. NIRS correlation with renal venous oximetry was worse for cyanotic versus noncyanotic patients ( p = 0.02).

CONCLUSIONS

Concordance and LOA of NIRS-derived oximetry with invasive venous oximetry in the cerebral and renal vascular beds was suboptimal for clinical decision-making. Cyanosis adversely affected NIRS performance in the renal site.

摘要

目的

尽管近红外光谱（NIRS）与侵入性血氧饱和度测定法相比存在不精确和广泛的协议范围（LOA）的问题，但它已被越来越多地接受为区域性组织氧合的非侵入性标志物。新一代绝对监测仪的准确性可能优于趋势监测仪。我们旨在比较一种新型的绝对 NIRS-血氧饱和度仪（FORESIGHT ELITE；CASMED，Branford，CT）与一种现代广泛使用的趋势监测仪（INVOS 5100C；Medtronic，Minneapolis，MN）与侵入性静脉血氧饱和度测定法的一致性。

设计

前瞻性单中心研究。

地点

三级儿科心脏中心。

患者

在全身麻醉下接受择期心导管检查的儿童。使用两种监测仪通过回归和 Bland-Altman 分析，将时间配对的静脉血氧饱和度样本（颈内和肾）与 NIRS 衍生的血氧饱和度进行比较。

干预措施

无。

测量和主要结果

我们纳入了 36 名儿童（19 名女性，10 名发绀），中位年龄为 4.1 岁（25-75%，2.5-7.8 岁），体重 16.7kg（12.3-29.1kg）。两种监测仪的 NIRS 衍生和侵入性颈内血氧饱和度之间的绝对差异小于 10%的情况占 67%。相关性为中等（Spearman rs = 0.40；p = 0.001），而 INVOS 5100C 的相关性较差（rs = 0.06；p = 0.71）。偏倚和 LOA 分别为+6.7%（+22%，-9%）和+1.3%（LOA =+24%，-21%）。FORESIGHT ELITE 中有 80%的情况下，NIRS 衍生和侵入性肾血氧饱和度之间的绝对差异小于 10%，相关性中等（rs = 0.57；p <0.001），INVOS 5100C 中有 61%的情况下，相关性中等（rs = 0.58；p <0.001）；偏倚和 LOA 分别为+3.6%（+19%，-12%）和-1.4%（+27%，-30%）。与非发绀患者相比，发绀患者的 NIRS 与肾静脉血氧饱和度的相关性更差（p = 0.02）。