Document Detail

Diagnosis influences response of cerebral near infrared spectroscopy to intracranial hypertension in children.
MedLine Citation:
PMID:  19935441     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To describe cerebral regional oxygen saturation measured by near infrared spectroscopy in the setting of normal and increased intracranial pressure in children to evaluate the association between cerebral regional oxygen saturation and intracranial pressure in comparison with other clinical variables.
DESIGN: Prospective observational cohort study.
SETTING: Two academic tertiary care centers' pediatric intensive care units.
PATIENTS: Thirty patients with intracranial pressure and near infrared spectroscopy monitoring (median age, 11.5 yrs; interquartile range, 5.2-13 yrs) for a range of neurologic diagnoses, including brain tumor, trauma, intracerebral hemorrhage, and hydrocephalus.
MEASUREMENTS AND MAIN RESULTS: Temporally correlated cerebral regional oxygen saturation with hematologic (hematocrit), biochemical (pH), and physiological (intracranial pressure, mean arterial pressure, cerebral perfusion pressure, temperature, heart rate, pulse oximetry and end-tidal carbon dioxide) variables. Cerebral regional oxygen saturation during episodes of increased intracranial pressure was lower than with normal intracranial pressure (mean +/- sd intracranial pressure >20 = 71% +/- 13% vs. intracranial pressure <20 = 75% +/- 10%), although the mean difference (-4%) is small compared with variability in the measurement. Neither isolated values nor change in cerebral regional oxygen saturation were significantly associated with intracranial pressure or cerebral perfusion pressure in the overall population. Isolated values and change in end-tidal CO2 were significantly correlated with cerebral regional oxygen saturation and change in cerebral regional oxygen saturation (all p < 0.01). In exploratory analyses, the diagnostic group significantly modified the effect of intracranial hypertension on regional oxygen saturation: regional oxygen saturation decreased during intracranial hypertension in patients with brain tumors (p = .05) and hydrocephalus (p < .001) but increased during intracranial hypertension in those with intracranial hemorrhage (p < .001).
CONCLUSIONS: These data suggest that cerebral regional oxygen saturation is lower with intracranial hypertension. However, the relationship between cerebral regional oxygen saturation and intracranial pressure is strongly influenced by diagnosis.
Maria T Zuluaga; Megan E Esch; Natalie Z Cvijanovich; Nalin Gupta; Patrick S McQuillen
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  11     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-07     Completed Date:  2010-12-07     Revised Date:  2013-06-11    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  514-22     Citation Subset:  IM    
Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
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MeSH Terms
Child, Preschool
Cohort Studies
Intensive Care Units, Pediatric
Intracranial Hypertension / etiology*
Monitoring, Physiologic / methods
Oxygen / blood
Prospective Studies
San Francisco
Spectroscopy, Near-Infrared*
Grant Support
Reg. No./Substance:
Comment In:
Pediatr Crit Care Med. 2010 Jul;11(4):535-6   [PMID:  20606559 ]

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