scholarly journals Cerebral Tissue Regional Oxygen Saturation as a Valuable Monitoring Parameter in Pediatric Patients Undergoing Extracorporeal Membrane Oxygenation

2021 ◽  
Vol 9 ◽  
Author(s):  
Song Chen ◽  
Fang Fang ◽  
Wenjun Liu ◽  
Chengjun Liu ◽  
Feng Xu
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Oxygen Saturation ◽  
Near Infrared ◽  
Pediatric Patients ◽  
Trial Registry ◽  
Cerebral Tissue ◽  
Clinical Trial Registry ◽  
Variation Trend ◽  
Regional Oxygen Saturation ◽  
Membrane Oxygenation

Objective: Brain function monitoring technology for extracorporeal membrane oxygenation (ECMO) support has been developing quite slowly. Our objective was to explore the data distribution, variation trend, and variability of cerebral tissue regional oxygen saturation (CrSO2) in pediatric patients undergoing ECMO.Methods: Eight patients who received venoarterial ECMO (V-A ECMO) were included in our study. All of them accepted continuous CrSO2 monitoring by near-infrared spectroscopy (NIRS) within 12 h of ECMO initiation until ECMO wean. Differences in the CrSO2 distribution characteristic, the variation trend of daily CrSO2, and the variability of CrSO2 for the first 5 days following ECMO initiation were compared between survivors and non-survivors according to pediatric intensive care unit (PICU) mortality.Results: The percentage of time of CrSO2 <60% against the whole monitoring time was significantly lower in survivors in both hemispheres {right: 4.34% [interquartile range (IQR) = 0.39–8.55%] vs. 47.45% [IQR = 36.03–64.52%], p = 0.036; left: 0.40% [IQR = 0.01–1.15%] vs. 30.9% [IQR = 26.92–49.62%], p = 0.036}. Survivors had significantly higher CrSO2 on the first 4 days. Root mean of successive squared differences (RMSSD), the variability variable of CrSO2, was significantly lower in survivors (right: 3.29 ± 0.79 vs. 6.16 ± 0.67, p = 0.002; left: 3.56 ± 1.20 vs. 6.04 ± 1.44, p = 0.039).Conclusion: Lower CrSO2, CrSO2 <60% over a longer period of time, and higher fluctuation of CrSO2 are likely associated with PICU mortality in pediatric patients undergoing V-A ECMO.Clinical Trial Registry: URL: http://www.chictr.org.cn/showproj.aspx?proj=46639, trial registry number: ChiCTR1900028021.

Can upper extremity (deltoid) near infrared spectroscopy be used to assess cerebral tissue bed saturation on femorally cannulated veno-arterial extracorporeal membrane oxygenation patients?

Perfusion ◽  
2020 ◽  
pp. 026765912090676
Author(s):  
James R Beck ◽  
David W Holt ◽  
Christine Chan ◽  
Kenmond Fung ◽  
Killian Patton-Rivera ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Extracorporeal Membrane Oxygenation ◽  
Upper Extremity ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Regression Line ◽  
Study Group ◽  
Cerebral Tissue ◽  
Membrane Oxygenation ◽  
Moment Coefficient

Continuous cerebral tissue saturation monitoring with near infrared spectroscopy may help clinicians identify cerebral desaturation early; however, patients have reported discomfort from near infrared spectroscopy monitoring pads on the forehead. This study aims to compare upper extremity near infrared spectroscopy monitoring to cerebral near infrared spectroscopy monitoring to assess its viability as a surrogate for cerebral saturation. A retrospective analysis of 10 femorally cannulated veno-arterial extracorporeal membrane oxygenation patients was performed comparing left (L) and right (R) upper extremity (deltoid) near infrared spectroscopy monitoring to cerebral near infrared spectroscopy monitoring (n = 20 data sets, 10 left and 10 right) and right radial blood gasses. Deltoid and cerebral near infrared spectroscopy values were recorded every 15 minutes for at least 24 hours when possible, were plotted on scatter grams, and were analyzed using Pearson product-moment coefficient (r). Based on the concept of covariance, a moderate-good relationship r = 0.50-0.75 was noted in 10% (n = 2) of the study group. A fair relationship r = 0.25-0.50 was noted in 50% (n = 10), and little or no relationship was noted in 40% (n = 8). None of the study group displayed a good to excellent relationship (r = 0.75 or above). In addition, coefficient of multiple determination for multiple regression R2 was calculated and strong fit of the regression line was not noted. Although cerebral near infrared spectroscopy monitoring has been extremely helpful in identifying low cerebral tissue saturation on veno-arterial extracorporeal membrane oxygenation patients, the use of upper extremity (peripheral deltoid) tissue monitoring does not provide adequate correlation and should not be used as a surrogate to cerebral monitoring.

scholarly journals Prognostic value of cerebral tissue oxygen saturation during neonatal extracorporeal membrane oxygenation

PLoS ONE ◽  
2017 ◽  
Vol 12 (3) ◽  
pp. e0172991 ◽  
Author(s):  
Marie-Philippine Clair ◽  
Jérôme Rambaud ◽  
Adrien Flahault ◽  
Romain Guedj ◽  
Julia Guilbert ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Oxygen Saturation ◽  
Prognostic Value ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen ◽  
Cerebral Tissue ◽  
Membrane Oxygenation ◽  
Cerebral Tissue Oxygen Saturation

scholarly journals P1246CEREBRAL TISSUE REGIONAL OXYGEN SATURATION AND BLOOD PRESSURE IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Georgios Spanos ◽  
Styliani Paschou ◽  
Christos Dontsios ◽  
Stylianos Fragkidis ◽  
Christos Bantis ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Oxygen Saturation ◽  
Vascular Disease ◽  
Near Infrared ◽  
Cerebral Tissue ◽  
Cerebral Disease ◽  
Regional Oxygen Saturation ◽  
Dialysis Vintage

Abstract Background and Aims Patients undergoing hemodialysis (HD) often develop cerebral disease complications. Cerebral tissue regional oxygen saturation (rSO2) through near-infrared spectroscopy (NIRS) is a non-invasive method for cerebral tissue oxygenation monitoring. The aim of the study was to investigate the relationship between rSO2 and hemodialysis in stable HD patients. Additionally, we wanted to investigate how blood pressure during HD is associated with rSO2. Method This is a single centre cross-sectional study in clinically stable HD patients. Cerebral rSO2 was monitored at the forehead 10min before, during and 10min after HD, using an INVOS 5100C device (Medtronic, United Kingdom). Results Thirty-nine stable HD patients (23 men and 16 women; mean age, 62.4 ± 14.6 years were recruited. Dialysis vintage was 65.7 ± 72.1 months, 9 patients had diabetes mellitus, 12 had vascular disease while 14 were smokers. The baseline rSO2 levels (49.6±9.1 %) were significantly lower in HD patients compared with historic results on healthy subjects. We found no difference in rSO2 results in patients with diabetes mellitus, vascular disease or smoking. Although we found a decrease (figure) in rSO2 when patients start dialysis (10min before vs 10min after starting dialysis 49.6±9.1 vs 48.1±9.9 %, p=0.021) rSO2 value returned to baseline after dialysis (10min before vs 10min after dialysis 49.6±9.1 vs 49.9±5.9 %, p=ns. Systolic blood pressure scientifically dropped during the first hour of dialysis (146.7 ± 21.1 vs 137.3 ± 24.6, p=0.03) and systolic blood pressure drop correlated with rSO2. Three patients developed hypotensive episodes requiring iv fluids but these hypotensive episodes had no correlation with rSO2 variations. Conclusion Cerebral rSO2 decreases while patients are on dialysis but return to baseline after dialysis. Blood pressure variations correlate with rSO2 levels but rSO2 do not forecast hypotensive episodes on dialysis.

Extracorporeal membrane oxygenation outcomes in children with hemophagocytic lymphohistiocytosis

Perfusion ◽  
2016 ◽  
Vol 32 (2) ◽  
pp. 151-156 ◽  
Author(s):  
Katherine Cashen ◽  
Roland L Chu ◽  
Justin Klein ◽  
Peter T Rycus ◽  
John M Costello
Keyword(s):  
Risk Factors ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiac Failure ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Pediatric Patients ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Hemorrhagic Complication ◽  
Membrane Oxygenation ◽  
Va Ecmo

Introduction: Pediatric patients with hemophagocytic lymphohistiocytosis (HLH) may develop refractory respiratory or cardiac failure that warrants consideration for extracorporeal membrane oxygenation (ECMO) support. The purposes of this study were to describe the use and outcomes of ECMO in pediatric HLH patients, to identify risk factors for hospital mortality and to compare their ECMO use and outcomes to the ECMO population as a whole. Methods: Pediatric patients (⩽ 18 years) with a diagnosis of HLH in the Extracorporeal Life Support Organization (ELSO) Registry were included. Results: Between 1983 and 2014, data for 30 children with HLH were available in the ELSO registry and all were included in this study. All cases occurred in the last decade. Of the 30 HLH patients, 24 (80%) had a respiratory indication for ECMO and six (20%) had a cardiac indication (of which 4 were E-CPR and 2 cardiac failure). Of the 24 respiratory ECMO patients, 63% were placed on VA ECMO. Compared with all pediatric patients in the ELSO registry during the study period (n=17,007), HLH patients had worse hospital survival (non-HLH 59% vs HLH 30%, p=0.001). In pediatric HLH patients, no pre-ECMO risk factors for mortality were identified. The development of a hemorrhagic complication on ECMO was associated with decreased mortality (p=0.01). Comparing HLH patients with respiratory failure to patients with other immune compromised conditions, the overall survival rate is similar (HLH 38% vs. non-HLH immune compromised 31%, p=0.64). Conclusions: HLH is an uncommon indication for ECMO and these patients have increased mortality compared to the overall pediatric ECMO population. These data should be factored into decision-making when considering ECMO for pediatric HLH patients.

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