Innovative Application of Cerebral rSO2 Monitoring During Shunt Tap in Pediatric Ventricular Malfunctioning Shunts. Issue 7 (July 2015)

• Record Type: Journal Article
• Authors: Abramo, Thomas J.; Zhou, Chuan; Estrada, Cristina; Meredith, Mark; Miller, Renee; Pearson, Matthew; Tulipan, Noel; Williams, Abby
• Is Part Of: Pediatric emergency care. Volume 31:Issue 7(2015)
• Publication Date: 2015-07
• Subjects: Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000000141
• Languages: English
• ISSNs: 0749-5161

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective</title> <p>This study aimed to determine the reliability and potential application of cerebral regional tissue oxygenation (rSO<sub>2</sub>) monitoring in malfunctioning ventricular shunts during tap.</p> </sec> <sec> <title>Methods</title> <p>This is a prospective case series using convenience sample in subjects with confirmed malfunctioning shunt who had left and right cerebral rSO<sub>2</sub> monitoring every 5 seconds before, during, and 1 hour after shunt tap.</p> </sec> <sec> <title>Results</title> <p>Ninety-four subjects had cerebral rSO<sub>2</sub> monitoring. Sixty-three subjects had proximal malfunctions, and 31 subjects had distal shunt malfunctions. The intrasubject's cerebral rSO<sub>2</sub> trend and variability at pretap, during, and posttap times were highly correlated. Overall, the average rSO<sub>2</sub> is lower in pretap as compared with posttap. Left cerebral rSO<sub>2</sub> had lower means and larger SD as compared with right cerebral rSO<sub>2</sub>. Left pretap and posttap cerebral rSO<sub>2</sub> variability was significantly associated with the location of shunt malfunction regardless of pretap, during, or posttap periods (<italic>P</italic> < 0.001), whereas right rSO<sub>2</sub> variability was not predictive for malfunction location. Left cerebral rSO<sub>2</sub> variability showed utility for identifying the location of malfunction with area under the receiver operating characteristic curve equal to 0.8.</p> </sec> <sec> <title>Conclusions</title> <p>Reliable cerebral rSO<sub>2</sub> readings before, during, and after shunt tap were demonstrated. Left cerebral rSO<sub>2</sub> changes from before to after shunt tap were more predictive for shunt malfunction location than right cerebral rSO<sub>2</sub> changes. Observing cerebral rSO<sub>2</sub> changes in relationship to shunt tap represents a potential surrogate in measuring cerebral pressures and blood flow changes after cerebral spinal fluid drainage. Significantly greater cerebral rSO<sub>2</sub> changes occur for distal malfunction versus proximal malfunction after shunt tap, indicating its potential as an adjunct tool for detecting shunt malfunction type.</p> </sec> </abstract>