Effect of volume resuscitation on regional perfusion in dehydrated pediatric patients as measured by two-site near-infrared spectroscopy.
OBJECTIVE
The aim of this study was to measure the change of cerebral and somatic regional oxygen saturation (rSO2) using near-infrared spectroscopic (NIRS) monitoring during volume resuscitation of dehydrated children.


METHODS
This prospective, observational study enrolled 17 moderately dehydrated children presenting to the emergency department in a tertiary care pediatric hospital. Pulse oximetry and 2-site rSO2 using forehead and flank NIRS probes were monitored continuously during intravenous rehydration.


RESULTS
Prehydration and posthydration data were summarized as mean (SD) and analyzed by paired 2-sided Student t test. Significance was defined as a P < 0.05. Pulse oximetry and cerebral rSO2 remained unchanged throughout rehydration. The somatic rSO2 increased from 79% (13) to 87% (9) (P < 0.01) with rehydration, and the somatic-cerebral rSO2 difference increased from 5% (7) to 13% (6) (P < 0.001). The high-volume rehydration group (33-40 mL/kg) showed a greater increase in somatic rSO2 with rehydration when compared with the low-volume rehydration group (20 mL/kg). The measured increase in somatic rSO2 was greatest in children weighing less than 15 kg.


CONCLUSIONS
In children with acute dehydration, cerebral rSO2 is preserved in moderate dehydration. Somatic tissue beds show an increase in rSO2 by NIRS oximetry with rehydration. Two-site NIRS monitoring is a continuous, noninvasive quantitative method for early detection of regional hypoperfusion in dehydrated children.
Hanson
Sheila J
SJ
Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA. shanson@mcw.edu
Berens
Richard J
RJ
Havens
Peter L
PL
Kim
Michael K
MK
Hoffman
George M
GM
D000293:Adolescent; D001921:Brain / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003681:Dehydration / Q000378:metabolism / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010092:Oximetry; D010100:Oxygen / Q000378:metabolism*; D010101:Oxygen Consumption / Q000502:physiology*; D010477:Perfusion / Q000379:methods; D011446:Prospective Studies; D015203:Reproducibility of Results; D012151:Resuscitation / Q000379:methods*; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D016896:Treatment Outcome
D010100:Oxygen