Cerebral regional oxygen saturation monitoring in pediatric malfunctioning shunt patients ★

BackgroundShunt malfunction produces increased intracranial pressure causing decreased cerebral regional perfusion and tissue O2sat. Cerebral regional oxygen saturation (rSO2) by near-infrared spectroscopy represents tissue perfusion and oxygen saturation. Cerebral rSO2 is used to detect cerebral ischemia in pediatric clinical settings.ObjectiveThe objective of the study was to determine the reliability of cerebral rSO2 in pediatric malfunctioning shunt.MethodsA prospective observational study of pediatric patients presented to the pediatric emergency department was conducted. Confirmed malfunctioning shunt subjects had cerebral rSO2 monitoring.ResultsA total of 131 malfunctioning shunt subjects had cerebral rSO2 monitoring. Patient's central trend and intrasubject variability of cerebral rSO2 readings for left and right probe and malfunction sites (n = 131) are as follows:VariableOverall, mean (SD)Distal, mean (SD)Proximal, mean (SD)PLeft probe trend69.1 (10.7)67.7 (9.81)70.0 (11.17).23Right probe trend71.3 (9.6)70.5 (8.13)71.8 (10.40).42Left probe variability3.57 (2.04)4.72 (2.55)2.88 (1.24)< .001Right probe variability3.46 (1.95)3.77 (2.20)3.28 (1.77).19Full-size tableTable optionsView in workspaceDownload as CSVIntrasubject left and right rSO2 Pearson correlation was − 0.46 to 0.98 (mean ± SD, 0.35 ± 0.34; median, 0.34; interquartile range, 0.06-0.61). The correlation coefficients of 99 subjects between left and right rSO2 was significantly different (P < .001), suggesting that intrasubjects' left and right rSO2 are highly correlated. Sample mean difference between left and right rSO2 were − 1.7% (95% confidence interval [CI], − 1.8 to − 1.6; P < .001) supporting overall left lower than right. Intraclass correlation for left rSO2 was 87.4% (95% CI, 87.2%-87.6%), and that for right rSO2 was 83.8% (95% CI, 83.8%-84%), showing intersubject differences accounting for the variation, and relative to intersubject variation, intrasubjects readings are consistent. Intrasubjects, left and right rSO2 highly correlate and are asymmetrical. Left and right rSO2 are consistent in intrasubject with large rSO2 variations in trend and variability across subjects.ConclusionThis study demonstrates reliable cerebral rSO2 readings in subjects with malfunctioning shunts, with asymmetrical cerebral rSO2 hemispheric dynamics within subjects.