Critical Care 3
Kaitlyn Miller, MD (she/her/hers)
Pediatric Resident Physician
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
Evaluate the utility of NIRS monitoring as an adjunctive tool for monitoring the severity of hypoxemia and/or tissue hypoxia in PARDS.
Patients admitted to a quaternary hospital PICU with PARDS from 1/1/18 to 8/1/21 were eligible. Inclusion criteria was age 1 month to 18 years old, confirmed diagnosis of PARDS requiring ventilatory support, and NIRS placed within 24 hours of diagnosis. Patients who had a history of chronic lung disease (due to inability to stratify severity), LV dysfunction, or pulmonary hypertension (due to inability to maintain permissive hypoxemia) were excluded. There were 74 patients that met the criteria.
The time of most severe OSI was determined by chart review. Renal and cerebral NIRS data from 12 hours before and 12 hours after that time point were evaluated. Correlations of OSI and NIRS were evaluated with Pearson’s correlation coefficients. A Mann-Whitney test was used to determine differences of continuous or ordinal variables between groups of alive vs deceased at discharge. A two-sided p-value of < 0.05 was used to determine statistical significance.
We noted a correlation between higher maximum OSI values and lower mean renal NIRS (r=-0.32, p-value=0.005). This trend was also significant when analyzed by hourly average area under the curve of renal NIRS (r=-0.30, p-value=0.010). There was no significant correlation of OSI with cerebral NIRS. No correlation was found with hospital length of stay.
This single-center retrospective study demonstrates that higher OSI values are correlated with lower renal NIRS. These findings suggest that tissue oxygen delivery and consumption as measured by NIRS may have a predictive value in PARDS outcomes.