Near-Infrared Spectroscopy (NIRS) Monitoring in Pediatric Shock, and The Effect of Fluid Resuscitation on Multisite NIRS Values

Objective: To study the effects of fluid resuscitation on cerebral (cSO2 ) and renal tissue oxygenation (cSO2 ) in pediatric shock patients. Methods: Prospective, observational study in a tertiary PICU (January- September 2016). We monitored bilateral cSO2 and rSO2 via NIRS during fluid resuscitation. Results: Twenty-five patients (56% female) with compensated shock were included. Median age was 19 months (IQR 10-85). Median weight was 12 kg (IQR 5.9-20). The mean left and right brain tissue oxygenation (cSO2 ) of the patients participating was 57.7±16.4 and 54.1±16.7, mean left and right kidney tissue oxygenation (rSO2 ) was 63.1 ±14.1, and 62.8 ±14.8. Tissue oxygen saturation increased significantly after fluid resuscitation The decline in lactate level and the increase in systolic and diastolic blood pressures was statistically significant. The median absolute differences between R-L cSO2 and rSO2 at time 0 were 5 (IQR 4-7), and 4 (IQR 1-9) respectively, but the difference was significant only for the brain (p=0.046). Bilateral cSO2 and rSO2 increased significantly after fluid bolus in survivors, whereas in non-survivors (n=9, 36%), there was no significant change. The mortality scores of the non survivors were higher than survivors (p<0.005). Conclusions: This study provides insights into laterality and pediatric cerebral and renal NIRS measurements in critically ill children and may facilitate the interpretation of NIRS data in critically ill patients. Further research with a larger cohort of healthy and critically ill patients is needed to confirm these findings.