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Damini Batra

Department of Paediatrics, Lady Hardinge Medical College, India

Title: Utility of near-infrared spectroscopy as a perfusion parameter in septic shock in children

Biography

Biography: Damini Batra

Abstract

Background: Shock is a state of tissue hypoxia wherein early recognition is associated with increased survival. Near-Infrared Spectroscopy (NIRS) is a promising tool to measure tissue oxygenation non-invasively and its saturation values have a good correlation with central venous oxygen saturation (ScvO2).

Aim: To assess whether NIRS variables (static-cerebral and peripheral saturations; dynamic- ischemic and reperfusion slopes) correlated with other parameters of septic shock and to judge their prognostic value.

Methods: This prospective observational study entailed 87 pediatric septic shock patients admitted in the emergency and PICU. Clinical, lab and NIRS parameters-static (cerebral and peripheral tissue oxygen saturations) and dynamic (by vaso-occlusive test) using INVOS Oximeter 7100 were recorded at baseline and pre-decided time intervals. Patients with severe acute malnutrition, chronic illnesses or brain pathology were excluded.

Results: The mean cerebral and peripheral saturation values were 63.38 and 50.55 respectively. The dynamic NIRS variables (ischemic and reperfusion slopes) showed a positive correlation with mean arterial pressure (Table 1). The correlations of CrSO2 and lactate were also statistically significant (p =0.0005, 0.000 and 0.001 at 0, 12 and 48 hours from admission respectively). All NIRS parameters at 24 and 48 hours had a strong significant correlation with pSOFA score (p=0.000). Persistently low cerebral and peripheral saturation values, ischemic and reperfusion slopes could well differentiate between survivors and non-survivors (Figure 1).

Conclusion: NIRS is a good non-invasive marker of impaired micro circulation especially when combined with vaso-occlusive testing. The measurements have a significant role in organ dysfunction and mortality prediction.

Keywords: Cerebral saturation, ischemic slope, Near-infrared spectroscopy (NIRS), reperfusion slope, septic shock