5969 Utility of near-infrared spectroscopy as a perfusion parameter in septic shock in children

Objectives 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).¹ 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. The correlation of NIRS parameters with clinical (mean arterial pressure, capillary refill time) and lab parameters (lactate and base excess) of perfusion, organ dysfunction in terms of pSOFA score and final clinical outcome was assessed. 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. Reference Crookes BA, Cohn SM, Bloch S, Amortegui J, Manning R, Li P, et al. Can near-infrared spectroscopy identify the severity of shock in trauma patients? J Trauma. 2005;58(4):806–13; discussion 813–816.