Perfusion Index Use and Clinical Follow-ups in the Pediatric Intensive Care Unit

Öz

Objective: Non-invasive measurements are used as standard methods in the hemodynamic follow-up of patients in the Pediatric Intensive Care Unit (PICU). The aim of this study is to investigate the usability of the perfusion index (PI), a non-invasive marker, in critically ill patients followed up in the PICU, to compare it with other vital signs and to analyze its utility in predicting mortality. Methods: Critically ill patients aged 1 month to 18 years with circulatory disorder, who were followed up in the intensive care unit between 01.June.2018 - 31.December.2019, were included in the study. PI, vital signs and mortality scores were compared within the first 6 hours after the patients were admitted to the intensive care unit. Results: When the values at the time of admission were examined, it was observed that the PI values were low, the capillary refill time (GFR) was long, and the lactate levels were high in those in the dehydration-acute gastroenteritis and metabolic disease groups. The patients were grouped as those with and without signs of dehydration. In the correlation analysis between 0th hour PI and KDZ, systolic blood pressure and lactate levels in the patient group with signs of dehydration; a moderate (respectively r=-0.53/0.11/-0.36) negative and significant (p<0.05) relationship was found. In the first 6-hour follow-up of patients who died after being admitted to the intensive care unit; PI, systolic blood pressure and mean diastolic blood pressure values were found to be lower (0.54/84.86/45.81, respectively) compared to discharged patients. When ROC analysis was performed for the PI values at the time of admission of patients with signs of dehydration and death, it was found that PI could predict mortality with a sensitivity of 70% and a specificity of 67.9% at a cutt-off value of 0.57. Conclusion: In critically ill patients followed up in the pediatric intensive care unit, PI measurement, which can be easily measured and is standard in many bedside monitors and pulse oximetry devices, can be used in the early detection of hemodynamic status, clinical follow-up, shock findings and mortality estimation, together with other vital signs.

Anahtar Kelimeler

• Perfusion index
• pediatric intensive care
• vital signs
• mortality

Çocuk Yoğun Bakım Ünitesi'nde Perfüzyon İndeksi Kullanımı ve Klinik İzlemleri

Öz

Amaç: Çocuk Yoğun Bakım Ünite’sinde (ÇYBÜ) invaziv olmayan ölçümler, hastaların hemodinamik izlemlerinde standart yöntemler olarak kullanılmaktadır. Bu çalışmanın amacı, ÇYBÜ’sinde takip edilen kritik hastalarda non-invaziv bir belirteç olan perfüzyon indeksinin (PI) kullanılabilirliğini araştırmak, diğer vital bulgularla karşılaştırmak ve mortaliteyi öngörmede kullanılabilirliğini analiz etmektir. Yöntem: 01.Haziran.2018 – 31.Aralık.2019 tarihleri arasında yoğun bakımda izlenen 1 ay-18 yaş arası dolaşım bozukluğu olan kritik hasta çalışmaya dahil edildi. Hastaların yoğun bakıma alındıktan sonraki ilk 6 saat içinde PI, vital bulguları ve mortalite skorları karşılaştırıldı. Bulgular: 0.saat değerleri incelendiğinde dehidratasyon-akut gastroenterit ve metabolik hastalık grubunda olanların PI değerleri düşük, kapiller dolum zamanı (KDZ) uzun ve laktat düzeyleri yüksek izlendi. Hastalar dehidratasyon bulgusu olan ve olmayan şeklinde gruplandırıldı. Dehidratasyon bulgusu olan hasta grubunda 0.saat PI ile KDZ, sistolik kan basıncı ve laktat düzeyleri arasında korelasyon analizinde; orta düzeyde (sırasıya r=-0,53/0,11/-0,36) negatif yönde ve anlamlı (p<0,05) ilişki bulundu. Yoğun bakıma yatırıldıktan sonra ölen hastaların ilk 6 saatlik takibinde; taburcu edilen hastalara göre PI, sistolik kan basıncı ve diyastolik kan basıncı ortalama değerleri daha düşük (sırasıyla 0.54/84,86/45,81) bulundu. Dehidratasyon bulgusu olan ve eksitus olan hastaların sıfırıncı saat PI değerleri için ROC analizi yapıldığında 0,57 Cutt off değerinde %70 sensitivite, %67,9 spesifite ile PI’nin mortaliteyi öngörebileceği saptandı. Sonuç: Çocuk yoğun bakım ünitesinde takip edilen kritik hastalarda, kolayca ölçülebilen ve pek çok hasta başı monitör ve pulse oksimetre cihazında standart olarak bulunan pahalı olmayan PI ölçümü, diğer vital bulgularla birlikte hastaların hemodinamik durumu, klinik izlemleri ve şok bulgularının erken tespitinde ve mortalite tahmininde kullanılabilir.

Anahtar Kelimeler

• Perfüzyon indeksi
• çocuk yoğun bakım
• vital bulgular
• mortalite

Kaynakça

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