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Influence of altitude on cerebral and splanchnic oxygen saturation in critically ill children during air ambulance transport

OBJECTIVE: The aim of the current study was to investigate how cerebral and splanchnic oxygen saturation (rSO(2)-C and rSO(2)-A) in critically ill children transported in air ambulance was affected by flight with cabin pressurization corresponding to ≥ 5000 feet. A second aim was to investigate any...

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Autores principales: Hannegård Hamrin, Tova, Eksborg, Staffan, Berner, Jonas, Fläring, Urban, Radell, Peter J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518599/
https://www.ncbi.nlm.nih.gov/pubmed/32976507
http://dx.doi.org/10.1371/journal.pone.0239272
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author Hannegård Hamrin, Tova
Eksborg, Staffan
Berner, Jonas
Fläring, Urban
Radell, Peter J.
author_facet Hannegård Hamrin, Tova
Eksborg, Staffan
Berner, Jonas
Fläring, Urban
Radell, Peter J.
author_sort Hannegård Hamrin, Tova
collection PubMed
description OBJECTIVE: The aim of the current study was to investigate how cerebral and splanchnic oxygen saturation (rSO(2)-C and rSO(2)-A) in critically ill children transported in air ambulance was affected by flight with cabin pressurization corresponding to ≥ 5000 feet. A second aim was to investigate any differences between cyanotic and non-cyanotic children in relation to cerebral and splanchnic oxygen saturation during flight ≥ 5000 feet. The variability of the cerebral and splanchnic Near Infrared Spectroscopy (NIRS) sensors was evaluated. DESIGN: NIRS was used to measure rSO(2)-C and rSO(2)-A during transport of critically ill children in air ambulance. rSO(2) data was collected and stored by the NIRS monitor and extracted and analyzed off-line after the transport. Prior to evaluation of the NIRS signals all zero and floor-effect values were removed. SETTING: The Pediatric Intensive Care Unit (PICU) at Astrid Lindgren Children’s Hospital, Karolinska University Hospital in Stockholm, Sweden. PATIENTS: In total, 44 critically ill children scheduled for inter-hospital transport by a specialized pediatric transport team were included in the study between January 2014 and January 2019 (convenience sampling). INTERVENTION: No interventions were conducted. MEASUREMENTS: All study patients were monitored with a cerebral NIRS-sensor placed over the forehead and an abdominal NIRS-sensor placed in the infra-umbilical area for cerebral and splanchnic regional oxygen saturation monitoring, rSO(2)-C and rSO(2)-A, respectively. MAIN RESULTS: Complete rSO(2)-C and rSO(2)-A data was obtained in 39 patients. Median age was 12 days. Cyanotic congenital heart malformations were present in 9 patients (23%). In 22 patients (56%) rSO(2)-C decreased at altitude ≥ 5000 feet and in 24 patients (61%) rSO(2)-A decreased at altitude ≥ 5000 feet compared to baseline (p<0.0001). In 25 patients (64%) the rSO(2)-C/rSO(2)-A ratio was greater at altitude ≥ 5000 feet than at baseline. A ratio ≥ 1 was seen in 77% of patients at altitude ≥ 5000 feet compared to in 67% of patients at baseline. CONCLUSION: Both cerebral and splanchnic oxygen saturation decreased at altitude ≥ 5000 feet compared to baseline. In most patients, both cyanotic and non-cyanotic, cerebral oxygen saturation was preserved more than splanchnic oxygen saturation.
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spelling pubmed-75185992020-10-01 Influence of altitude on cerebral and splanchnic oxygen saturation in critically ill children during air ambulance transport Hannegård Hamrin, Tova Eksborg, Staffan Berner, Jonas Fläring, Urban Radell, Peter J. PLoS One Research Article OBJECTIVE: The aim of the current study was to investigate how cerebral and splanchnic oxygen saturation (rSO(2)-C and rSO(2)-A) in critically ill children transported in air ambulance was affected by flight with cabin pressurization corresponding to ≥ 5000 feet. A second aim was to investigate any differences between cyanotic and non-cyanotic children in relation to cerebral and splanchnic oxygen saturation during flight ≥ 5000 feet. The variability of the cerebral and splanchnic Near Infrared Spectroscopy (NIRS) sensors was evaluated. DESIGN: NIRS was used to measure rSO(2)-C and rSO(2)-A during transport of critically ill children in air ambulance. rSO(2) data was collected and stored by the NIRS monitor and extracted and analyzed off-line after the transport. Prior to evaluation of the NIRS signals all zero and floor-effect values were removed. SETTING: The Pediatric Intensive Care Unit (PICU) at Astrid Lindgren Children’s Hospital, Karolinska University Hospital in Stockholm, Sweden. PATIENTS: In total, 44 critically ill children scheduled for inter-hospital transport by a specialized pediatric transport team were included in the study between January 2014 and January 2019 (convenience sampling). INTERVENTION: No interventions were conducted. MEASUREMENTS: All study patients were monitored with a cerebral NIRS-sensor placed over the forehead and an abdominal NIRS-sensor placed in the infra-umbilical area for cerebral and splanchnic regional oxygen saturation monitoring, rSO(2)-C and rSO(2)-A, respectively. MAIN RESULTS: Complete rSO(2)-C and rSO(2)-A data was obtained in 39 patients. Median age was 12 days. Cyanotic congenital heart malformations were present in 9 patients (23%). In 22 patients (56%) rSO(2)-C decreased at altitude ≥ 5000 feet and in 24 patients (61%) rSO(2)-A decreased at altitude ≥ 5000 feet compared to baseline (p<0.0001). In 25 patients (64%) the rSO(2)-C/rSO(2)-A ratio was greater at altitude ≥ 5000 feet than at baseline. A ratio ≥ 1 was seen in 77% of patients at altitude ≥ 5000 feet compared to in 67% of patients at baseline. CONCLUSION: Both cerebral and splanchnic oxygen saturation decreased at altitude ≥ 5000 feet compared to baseline. In most patients, both cyanotic and non-cyanotic, cerebral oxygen saturation was preserved more than splanchnic oxygen saturation. Public Library of Science 2020-09-25 /pmc/articles/PMC7518599/ /pubmed/32976507 http://dx.doi.org/10.1371/journal.pone.0239272 Text en © 2020 Hannegård Hamrin et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Hannegård Hamrin, Tova
Eksborg, Staffan
Berner, Jonas
Fläring, Urban
Radell, Peter J.
Influence of altitude on cerebral and splanchnic oxygen saturation in critically ill children during air ambulance transport
title Influence of altitude on cerebral and splanchnic oxygen saturation in critically ill children during air ambulance transport
title_full Influence of altitude on cerebral and splanchnic oxygen saturation in critically ill children during air ambulance transport
title_fullStr Influence of altitude on cerebral and splanchnic oxygen saturation in critically ill children during air ambulance transport
title_full_unstemmed Influence of altitude on cerebral and splanchnic oxygen saturation in critically ill children during air ambulance transport
title_short Influence of altitude on cerebral and splanchnic oxygen saturation in critically ill children during air ambulance transport
title_sort influence of altitude on cerebral and splanchnic oxygen saturation in critically ill children during air ambulance transport
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518599/
https://www.ncbi.nlm.nih.gov/pubmed/32976507
http://dx.doi.org/10.1371/journal.pone.0239272
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