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Published on: August 19, 2020
Evaluation of cerebral oxygenation during procedural sedation in children using near infrared spectroscopy
Pradeep Padmanabhan1, John W Berkenbosch, Doug Lorenz
1Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Louisville, Louisville, KY, USA. p0padm01@gwise.louisville.edu
Insights
Near infrared spectroscopy (NIRS) monitoring showed few changes in cerebral oxygenation during pediatric procedural sedation. However, cerebral desaturations often occurred without changes in conventional respiratory monitors.
Area of Science:
- Anesthesiology
- Pediatric critical care
- Neuroscience
Background:
- Procedural sedation in children carries risks of cardiorespiratory compromise.
- Monitoring cerebral oxygenation is crucial during sedation.
- Near infrared spectroscopy (NIRS) offers a non-invasive method to assess cerebral oxygenation.
Purpose of the Study:
- To evaluate the utility of NIRS monitoring for cerebral oxygenation.
- To assess the correlation between NIRS and conventional respiratory monitors (pulse oximetry and end-tidal carbon dioxide) during pediatric procedural sedation.
- To investigate changes in cerebral oxygenation during adverse cardiorespiratory events.
Main Methods:
- Prospective observational study of 100 pediatric patients undergoing procedural sedation.
- Continuous monitoring of cerebral oxygenation (rSO(2)) via NIRS, pulse oximetry (SpO(2)), and end-tidal carbon dioxide (etco(2)).
- Correlation analysis between rSO(2), SpO(2), and etco(2), particularly during cardiorespiratory events.
Main Results:
- Cerebral oxygenation (rSO(2)) remained normal in 97.9% of measurements.
- Significant rSO(2) decreases were observed during a small proportion of hypoxic and hypercarbic events.
- Hypercarbia had a greater effect on rSO(2) than hypoxemia.
- Cerebral desaturations occurred frequently without associated changes in SpO(2) or etco(2).
Conclusions:
- NIRS monitoring demonstrated minimal significant negative changes in cerebral oxygenation during pediatric procedural sedation.
- Transient cardiorespiratory events seldom impacted cerebral oxygenation.
- Cerebral desaturations detected by NIRS may occur independently of conventional respiratory monitoring parameters.
Study Objective:
We evaluate the utility of near infrared spectroscopy monitoring and its correlation to conventional respiratory monitors during changes in cardiorespiratory characteristics during pediatric procedural sedation.
Methods:
In this prospective observational study of 100 children, cerebral oxygenation (rSO(2)), pulse oximetry (SpO(2)), and end-tidal carbon dioxide (etco(2)) were monitored continuously. Values were manually recorded at least every 3 minutes from baseline until 30 minutes after sedative administration, resulting in 1,515 triplicate (simultaneous near infrared spectroscopy/etco(2)/SpO(2)) measurements. Correlations between conventional monitoring characteristics (SpO(2) and etco(2)) and rSO(2) were determined, with focus during adverse cardiorespiratory events.
Results:
Cerebral oxygenation remained normal in 1,483 of 1,515 measurements (97.9%). rSO(2) decreased significantly during 3 of 13 hypoxic events occurring in 13 patients and during 5 of 17 hypercarbic events occurring in 8 patients, with 15 measurements of greater than 20% decrease from baseline. Cerebral oxygenation increased transiently in 88% of children. During 31 cerebral desaturation recordings, 3 hypoxic recordings (9.3%, always in combination with hypercarbia) and 5 hypercarbic recordings (15.6%) were observed, whereas in 23 (74.2%), cardiorespiratory characteristics were unchanged. There was poor correlation between rSO(2) and both SpO(2) and etco(2), with correlation coefficients of 0.05 (95% confidence interval 0.04 to 0.07) and 0.01 (95% confidence interval -0.01 to 0.02), respectively.
Conclusion:
Cerebral oxygenation as measured by near infrared spectroscopy demonstrated few significant negative changes during pediatric procedural sedation. Transient cardiorespiratory events seldom altered rSO(2), with hypercarbia having a greater effect than hypoxemia. However, cerebral desaturations frequently occurred without associated cardiorespiratory changes.
