Facebook Twitter YouTube



Practical Use of near Infrared Spectroscopy In a Pediatric Transport Population

Sunday, October 21, 2012: 4:00 PM
Room 211-213 (Morial Convention Center)
Heather Carter, RN, BSN1, Jane Dunnagan, RRT, RCP1, Randy Edwards, NPS, RRT, RCP1, Scott Jamie, NPS, RRT, RCP1, Tammy Rush, RN, BSN, C-NPP, EMT1 and Samuel Ajizian, MD, FAAP2, (1)Brenner Children's Hospital Critical Care Transport Team, WakeHealth, Winston Salem, NC, (2)Anesthesia, Pediatric Critical Care, Wake Forest University School of Medicine, Winston Salem, NC

Purpose: Near Infrared Spectroscopy (NIRS) is a noninvasive monitoring technology becoming widely used in children's hospitals.  NIRS measures regional end organ mixed capillary saturation, and is an adjunct to standard monitoring in critical patients.  We sought to evaluate the utility of bringing NIRS to the critical care transport environment by analyzing the prevalence of NIRS signal dropout in neonates and older patients in both the ground and air transport environment.

Methods: Our team employed an INVOS NIRS monitor and standard neonatal and pediatric cerebral and somatic sensors (Covidien, Boulder, CO, USA) in select patients over a 1 month period. Monitor data was downloaded, and cerebral and perirenal regional saturation data was analyzed looking specifically for periods of signal dropout while on transport. 

Group

Average Weight (kg)

Average Time of Transport in min. (Range of 5.11-225.51)

Average Time Cerebral Drop Out in min. (Range 0.00-17.39)

Average Time Perirenal Drop Out in min. (Range 0.00-25.50)

% Of Total Transport Time w/ Cerebral     Drop Out

% Of Total Transport Time w/ Perirenal Drop Out

Neonatal (< 1 mo.)

N=16

2.76

58.11

5.17

3.38

8.9%

5.8%

Pediatric (> 1 mo.)

N=5

12.2

78.59

0.26

0.00

0.33%

0%

Results: Table 1 summarizes results for both cerebral and perirenal signal dropout.

Table 1

The total number of patients was 22, with 16 being neonates. Of these, 12 were newborns.  Of the 22 transports, one was rotary wing for a 3 year old, and one was fixed wing for a 5 month old. Of note, no dropout occurred in either mode of air transport.  Our overall rate of signal dropout was extremely low and quite acceptable. We observed no signal dropout attributed directly to the monitor, sensors, or patient being in the transport environment.

Conclusion: To date, there has been no published neonatal/pediatric data describing using NIRS in a transport environment.  Weatherall et.al. described excellent functionality of the technology with use of light shielding for both air and ground transport in adults in Australia1, but used a different brand of NIRS monitor than our group, and examined only cerebral sensing and not somatic.   Unlike the Australian group, we did not lose signal due to ambient light interference, which may be a characteristic of the specific brand used in that trial. 

Our small pilot study confirms that INVOS NIRS is indeed a technically viable tool in the neonatal and pediatric transport environment for both air and ground. Our group will now aim to study the impact this important technology can make in managing critically ill patients in transport. 

1. Weatherall, A, Skwono, J, Lansdown, A, Lupton, T, Garner, A; Feasibility of cerebral near-infrared spectroscopy monitoring in the pre-hospital environment: Acta Aneaesthesiol Scand. 2012 Feb; 56 (2):172-7.