Adequate agreement between venous oxygen saturation in right atrium and pulmonary artery in critically ill children.
OBJECTIVE
To determine the agreement between venous oxygen saturation in right atrium (Srao2) and pulmonary artery (Svo2) in critically ill pediatric patients.


METHODS
Retrospective, observational study.


METHODS
Multidisciplinary pediatric intensive care unit from a general university hospital.


METHODS
Thirty critically ill children in whom a pulmonary artery catheter (PAC) was inserted for catecholamine refractory shock (septic and cardiogenic, n = 18) and postoperative management (liver and cardiac transplant, n = 12).


RESULTS
Ninety measurements of Srao2 and Svo2 were obtained after placement of PAC and every 6 hrs for the first 12 hrs of pediatric intensive care unit admission. The agreement between Srao2 and Svo2 was determined through Bland and Altman methodology, concordance correlation coefficient, and the frequency of differences between Srao2 and Svo2. The frequency of differences between both saturations was evaluated in three categories: +/-1%-5%, +/-6%-9%, and higher than +/-10%. The first category was the threshold to consider both variables interchangeable. Changes of Srao2 related to clinically significant (>5%) increases and drops of Svo2 were analyzed. Srao2 and Svo2 were not significantly different: median (interquartile range) 83% (75%-86%) and 81% (75%-85%), respectively (p = 0.23). The frequency of differences between Srao2 and Svo2 was +/-1%-5%, 71 (79%); +/-6%-9%, 14 (15.5%); and higher than +/-10%, 5 (5.5%). Bland and Altman analysis showed a 2% bias with a 95% limits of agreement of -6.9% to 10.9%. The concordance correlation coefficient was 0.90. Svo2 increased in 11/90 measurements and Srao2 followed it 82% of the times. Svo2 decreased in 7/90 measurements and Srao2 followed it 100% of the times.


CONCLUSIONS
The concordance analysis performed allows to conclude that there is an appropriate agreement between Svo2 and Srao2. This finding may become clinically relevant considering the difficulties associated to the use of PAC in children.
Pérez
Augusto C
AC
Pediatric Intensive Care Unit, Hospital Italiano de Buenos Aires, Asociado a la Universidad de Buenos Aires, Argentina. cesar.perez@hospitalitaliano.org.ar
Eulmesekian
Pablo G
PG
Minces
Pablo G
PG
Schnitzler
Eduardo J
EJ
D000293:Adolescent; D002407:Catheterization, Swan-Ganz / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy; D005260:Female; D006325:Heart Atria / Q000378:metabolism; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D010092:Oximetry; D010100:Oxygen / Q000032:analysis / Q000097:blood*; D011336:Probability; D011651:Pulmonary Artery / Q000378:metabolism; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014683:Vena Cava, Superior / Q000502:physiology
D010100:Oxygen