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The Regional Cerebral Oxygenation Monitoring of Pediatric Patients Presenting with Neurological Emergencies to a Pediatric Emergency Department

Friday, October 19, 2012
Room 272-273 (Morial Convention Center)
Brian S. Bassham, MD1, Thomas J. Abramo2, Mark Meredith, M.D.2, Matthew Locklair, MD3, Byrd Lindsey, RN, 3-CC, VPNPP2, Abby M. Williams, MD2 and Cristina Maria Estrada, MD4, (1)Pediatric Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, (2)Pediatric Emergency Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, (3)Pediatric Emergency Medicine, Monroe Carrell Junior Children's Hospital, Nashville, TN, (4)Pediatrics, Vanderbilt University Medical Center, Brentwood, TN

Purpose: Pediatric neurological emergencies often present with a broad clinical picture and limited historical information. A method of noninvasive detection and monitoring of cerebral physiology during these neurological emergencies would greatly enhance the opportunity for early and appropriate neurological resuscitation and intervention.  Near-infrared spectroscopy (NIRS) has been proven to noninvasively measure regional cerebral tissue oxygen saturation (rcSO2) and provide trending data that reflects the cerebral perfusion, oxygen delivery, extraction and metabolism of the patient's condition. A 15% rcSO2 represents no detectable tissue O2HgB while 95% rcSO2 is reflective of an increase in perfusion with little or no oxygen tissue extraction. Numerous adult and pediatric studies have demonstrated the successful application of NIRS in various neurological emergencies.  This descriptive retrospective case review describes cerebral rcSO2 monitoring as depicted by their rSO2 graphs. These graphs detail a representation of the continuous cerebral monitoring of children presenting to the pediatric emergency department (PED) with suspected neurological emergencies.  

Methods:  During the period of 1/09 - 2/12, 33 patients presented to the PED with signs or symptoms for AMS, seizures, febrile seizure, status epilepticus, or head trauma with vomiting. These patients had NIR probes placed on right and left forehead with recordings every 5 or 30 seconds during their stabilization and evaluation. The electronic medical records (EMR) of their emergency department and inpatient hospital stays were reviewed.

Results: Average age 18.9 months, SD 16.9 months, 64% male. The medical patients had idiopathic seizures, febrile seizures, status epilepticus, viral meningitis with seizures, and encephalitis.  Also, a subset of these altered patients post facto had a traumatic etiology of NAT, TBI, epidural hematoma, subdural hematoma, and AVM with herniation.

Figure 1:  Patient's Cerebral rcSO2 & Somatic rsSO2 Graphs

Description: abramo:Users:tja:Desktop:33 graph layout.jpg

Conclusion: The small sample size precludes any definitive conclusions, but our observations reveal the significance of noninvasive rsSO2 during the stabilization of patients presenting with neurological emergencies.  Review of the NIRS trending patterns for these patients demonstrates unique correlation of their cerebral rcSO2 readings with their specific etiologies. Given the promise of these observations, a large diverse validation study utilizing NIR monitoring along with other global noninvasive monitoring parameters is warranted in the pediatric population.