Near-infrared Spectroscopy in Transport With a Patient in Multi-factorial Shock

Area of Science:

• Cardiology
• Pediatric Critical Care
• Biomedical Engineering

Background:

• A 14-year-old male with a history of repaired truncus arteriosus presented with respiratory distress, anuria, and poor perfusion.
• The patient had severe right ventricle to pulmonary artery conduit stenosis, a known complication post-surgical repair.

Observation:

• Vital signs upon arrival indicated significant compromise: tachypnea (RR 48), tachycardia (HR 153), hypotension (BP 81/52), and poor peripheral perfusion.
• Near-infrared spectroscopy (NIRS) revealed critically low cerebral (71%) and renal (39%) oxygen saturation, indicating inadequate organ perfusion.

Findings:

• Interventions including epinephrine and norepinephrine infusions, guided by NIRS, led to improved perfusion parameters during transport.
• Post-transfer, renal NIRS improved to 53%, and cerebral NIRS to 75%, correlating with improved hemodynamics (BP 91/51).

Implications:

• This case demonstrates the utility of NIRS in real-time assessment of organ perfusion in critically ill pediatric patients during interfacility transport.
• Continuous NIRS monitoring can guide therapeutic interventions and assess their efficacy in managing complex congenital heart disease patients with circulatory compromise.