Objective: To study the effects of fluid resuscitation on cerebral (cSO2 ) and renal tissue oxygenation (cSO2 ) in pediatric shock patients.
Methods: Prospective, observational study in a tertiary PICU (January- September 2016). We monitored bilateral cSO2 and rSO2 via NIRS during fluid resuscitation.
Results: Twenty-five patients (56% female) with compensated shock were included. Median age was 19 months (IQR 10-85). Median weight was 12 kg (IQR 5.9-20). The mean left and right brain tissue oxygenation (cSO2 ) of the patients participating was 57.7±16.4 and 54.1±16.7, mean left and right kidney tissue oxygenation (rSO2 ) was 63.1 ±14.1, and 62.8 ±14.8. Tissue oxygen saturation increased significantly after fluid resuscitation The decline in lactate level and the increase in systolic and diastolic blood pressures was statistically significant. The median absolute differences between R-L cSO2 and rSO2 at time 0 were 5 (IQR 4-7), and 4 (IQR 1-9) respectively, but the difference was significant only for the brain (p=0.046). Bilateral cSO2 and rSO2 increased significantly after fluid bolus in survivors, whereas in non-survivors (n=9, 36%), there was no significant change. The mortality scores of the non survivors were higher than survivors (p<0.005).
Conclusions: This study provides insights into laterality and pediatric cerebral and renal NIRS measurements in critically ill children and may facilitate the interpretation of NIRS data in critically ill patients. Further research with a larger cohort of healthy and critically ill patients is needed to confirm these findings.
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Hoffman, G.M.; Ghanayem, N.S.; Tweddell, J. S. Noninvasive assessment of cardiac output. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2005:12-21 google scholar
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Austin III, E. H., Edmonds Jr, H. L., Auden, S. M., Seremet, V., Niznik, G., Sehic, A. et. al. Benefit of neurophysiologic monitoring for pediatric cardiac surgery. J Thorac Cardiovasc Surg. 1997 Nov;114(5):707-15, 717; discussion 715-6. google scholar
Chakravarti, S., Srivastava S, Mittnacht AJ. A.J. Near-infrared spectroscopy (NIRS) in children. Semin Cardiothorac Vasc Anesth. 2008 Mar;12(1):70-9 google scholar
Hanson, S.J.; Berens, R.J.; Havens, P.L.; Kim, M.K.; Hoffman, G. M. Pediatr Emerg Care. 2009 Mar;25(3):150-3. google scholar
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Balakrishnan, B., Dasgupta, M., Gajewski, K., Hoffmann, R. G., Simpson, P. M., Havens, P. L. et. al. Low near-infrared spectroscopic somatic oxygen saturation at admission is associated with need for lifesaving interventions among unplanned admissions to the pediatric intensive care unit. J Clin Monit Comput. 2018 Feb;32(1):89-96. google scholar
Lima, A., van Bommel, J., Jansen, T. C., Ince C, Bakker J. Low tissue oxygen saturation at the end of early goal-directed therapy is associated with worse outcome in critically ill patients. Crit Care.2009;13 Suppl 5(Suppl 5): S13. google scholar
Vorwerk C, Coats TJ. The prognostic value of tissue oxygen saturation in emergency department patients with severe sepsis or septic shock. Emerg Med J. 2012 Sep;29(9):699-703. google scholar
Austin EH 3rd, Edmonds HL Jr, Auden SM, Seremet V, Niznik G, Sehic A et. al. Benefit of neurophysiologic monitoring for pediatric cardiac surgery. J Thorac Cardiovasc Surg. 1997 Nov;114(5):707-15, 717; discussion 715-6. google scholar
Kamba, M., Sung YW, Ogawa S. Alteration of blood oxygenation level-dependent signaling by local circulatory condition. J Magn Reson Imaging. 2007 Dec;26(6):1506-13. google scholar
Bartocci, M., Winberg, J., Papendieck, G., Mustica, T., Serra G, Lagercrantz H. Cerebral hemodynamic response to unpleasant odors in the preterm newborn measured by near-infrared spectroscopy. Pediatr Res. 2001 Sep;50(3):324-30. google scholar
Lemmers P, Van Bel F. Left-to-right differences of regional cerebral oxygen saturation and oxygen extraction in preterm infants during the first days of life. Pediatr Res. 2009 Feb;65(2):226-30. google scholar
Kussman, B. D., Wypij, D., DiNardo, J. A., Newburger, J., Jonas, R. A., Bartlett, J. et. al. An evaluation of bilateral monitoring of cerebral oxygen saturation during pediatric cardiac surg Anesth Analg. 2005 Nov;101(5): 1294-1300.ery. google scholar
Öztürk, N. Y., Aygün, B., Uyar, E., & Girgin, F. İ. Comparison of Bilateral Cerebro-Renal Tissue Oxygenations in Healthy Children. Indian J Pediatr. 2020 Feb;87(2):99-10 google scholar
Brierley, J., Carcillo, J. A., Choong, K., Cornell, T., DeCaen, A., Deymann, A. et. al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009 Feb;37(2):666-88. google scholar
Sinha, R., Nadel, S., Kissoon, N., Ranjit, S., Shaffner DH, Nichols DG. Recognition, and initial management of shock. Rogers’ Textbook of Pediatric Intensive Care. 2016th ed. Wolters Kluwer, 2016, 380-92. google scholar
Hilarius, K.W.; Skippen, P.W.; Kissoon, N. Early recognition and emergency treatment of sepsis and septic shock in children. Pediatr Emerg Care. 2020 Feb;36(2):101-106. google scholar
Davis, A. L., Carcillo, J. A., Aneja, R. K., Deymann, A. J., Lin, J. C., Nguyen, T. C. et. al. American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. 2017 Jun;45(6):1061-1093. google scholar
Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich, B. et. al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8;345(19):1368-77. google scholar
Ince, C. Hemodynamic coherence and the rationale for monitoring the microcirculation. Crit Care. 2015;19 Suppl 3(Suppl 3): S8. google scholar
Arteaga, G.M. and Crow, S. End organ perfusion and pediatric microcirculation assessment. Front Pediatr. 2023 Sep 29:11:1123405. google scholar
Huber, W., Zanner, R., Schneider, G., Schmid R, Lahmer T. Assessment of regional perfusion and organ function: less and non-invasive techniques. Front Med (Lausanne). 2019:6:50. google scholar
Hariri, G., Joffre, J., Leblanc, G., Bonsey, M., Lavillegrand, J. R., Urbina, et. al. Narrative review: clinical assessment of peripheral tissue perfusion in septic shock. Ann Intensive Care. 2019; 9:37. google scholar
Donnelly, P., & Fine-Goulden, M. R. How to use near-infrared spectroscopy. Arch Dis Child Educ Pract Ed. 2020 Feb;105(1):58-63. google scholar
Hoffman, G.M.; Ghanayem, N.S.; Tweddell, J. S. Noninvasive assessment of cardiac output. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2005:12-21 google scholar
Levy, W. J., Levin S, Chance B. Near-infrared measurement of cerebral oxygenation: correlation with electroencephalographic ischemia during ventricular fibrillation. Anesthesiology. 1995 Oct;83(4):738-46. google scholar
Austin III, E. H., Edmonds Jr, H. L., Auden, S. M., Seremet, V., Niznik, G., Sehic, A. et. al. Benefit of neurophysiologic monitoring for pediatric cardiac surgery. J Thorac Cardiovasc Surg. 1997 Nov;114(5):707-15, 717; discussion 715-6. google scholar
Chakravarti, S., Srivastava S, Mittnacht AJ. A.J. Near-infrared spectroscopy (NIRS) in children. Semin Cardiothorac Vasc Anesth. 2008 Mar;12(1):70-9 google scholar
Hanson, S.J.; Berens, R.J.; Havens, P.L.; Kim, M.K.; Hoffman, G. M. Pediatr Emerg Care. 2009 Mar;25(3):150-3. google scholar
Borg, U., Katilius JZ, Addison PS. Near-Infrared Spectroscopy Monitoring to Detect Changes in Cerebral and Renal Perfusion During Hypovolemic Shock, Volume Resuscitation, and Vasoconstriction. Mil Med. 2023 Nov 8;188(Suppl 6):369-376. google scholar
Al Tayar, A.; Abouelela, A.; Mohiuddeen, K. Can the cerebral regional oxygen saturation be a perfusion parameter in shock? J Crit Care. 2017 Apr: 38:164-167. google scholar
Balakrishnan, B., Dasgupta, M., Gajewski, K., Hoffmann, R. G., Simpson, P. M., Havens, P. L. et. al. Low near-infrared spectroscopic somatic oxygen saturation at admission is associated with need for lifesaving interventions among unplanned admissions to the pediatric intensive care unit. J Clin Monit Comput. 2018 Feb;32(1):89-96. google scholar
Lima, A., van Bommel, J., Jansen, T. C., Ince C, Bakker J. Low tissue oxygen saturation at the end of early goal-directed therapy is associated with worse outcome in critically ill patients. Crit Care.2009;13 Suppl 5(Suppl 5): S13. google scholar
Vorwerk C, Coats TJ. The prognostic value of tissue oxygen saturation in emergency department patients with severe sepsis or septic shock. Emerg Med J. 2012 Sep;29(9):699-703. google scholar
Austin EH 3rd, Edmonds HL Jr, Auden SM, Seremet V, Niznik G, Sehic A et. al. Benefit of neurophysiologic monitoring for pediatric cardiac surgery. J Thorac Cardiovasc Surg. 1997 Nov;114(5):707-15, 717; discussion 715-6. google scholar
Kamba, M., Sung YW, Ogawa S. Alteration of blood oxygenation level-dependent signaling by local circulatory condition. J Magn Reson Imaging. 2007 Dec;26(6):1506-13. google scholar
Bartocci, M., Winberg, J., Papendieck, G., Mustica, T., Serra G, Lagercrantz H. Cerebral hemodynamic response to unpleasant odors in the preterm newborn measured by near-infrared spectroscopy. Pediatr Res. 2001 Sep;50(3):324-30. google scholar
Lemmers P, Van Bel F. Left-to-right differences of regional cerebral oxygen saturation and oxygen extraction in preterm infants during the first days of life. Pediatr Res. 2009 Feb;65(2):226-30. google scholar
Kussman, B. D., Wypij, D., DiNardo, J. A., Newburger, J., Jonas, R. A., Bartlett, J. et. al. An evaluation of bilateral monitoring of cerebral oxygen saturation during pediatric cardiac surg Anesth Analg. 2005 Nov;101(5): 1294-1300.ery. google scholar
Öztürk, N. Y., Aygün, B., Uyar, E., & Girgin, F. İ. Comparison of Bilateral Cerebro-Renal Tissue Oxygenations in Healthy Children. Indian J Pediatr. 2020 Feb;87(2):99-10 google scholar
Feyza Incekoy Girgin
Marmara University Faculty of Medicine, Department of Pediatric Intensive Care, Department of Child Health and Diseases0000-0003-4324-0488Türkiye
Emel Uyar
Marmara University Faculty of Medicine, Department of Pediatric Intensive Care, Department of Child Health and Diseases0000-0002-8265-0618Türkiye
Nilüfer Yalındağ Öztürk
Bu kişi benim
Marmara University Faculty of Medicine, Department of Pediatric Intensive Care, Department of Child Health and Diseases0000-0001-7040-2812Türkiye
Aygün, B., Incekoy Girgin, F., Uyar, E., Yalındağ Öztürk, N. (2025). Near-Infrared Spectroscopy (NIRS) Monitoring in Pediatric Shock, and The Effect of Fluid Resuscitation on Multisite NIRS Values. Çocuk Dergisi, 24(3), 136-140. https://doi.org/10.26650/jchild.2024.1532366
AMA
Aygün B, Incekoy Girgin F, Uyar E, Yalındağ Öztürk N. Near-Infrared Spectroscopy (NIRS) Monitoring in Pediatric Shock, and The Effect of Fluid Resuscitation on Multisite NIRS Values. Çocuk Dergisi. Ocak 2025;24(3):136-140. doi:10.26650/jchild.2024.1532366
Chicago
Aygün, Burcu, Feyza Incekoy Girgin, Emel Uyar, ve Nilüfer Yalındağ Öztürk. “Near-Infrared Spectroscopy (NIRS) Monitoring in Pediatric Shock, and The Effect of Fluid Resuscitation on Multisite NIRS Values”. Çocuk Dergisi 24, sy. 3 (Ocak 2025): 136-40. https://doi.org/10.26650/jchild.2024.1532366.
EndNote
Aygün B, Incekoy Girgin F, Uyar E, Yalındağ Öztürk N (01 Ocak 2025) Near-Infrared Spectroscopy (NIRS) Monitoring in Pediatric Shock, and The Effect of Fluid Resuscitation on Multisite NIRS Values. Çocuk Dergisi 24 3 136–140.
IEEE
B. Aygün, F. Incekoy Girgin, E. Uyar, ve N. Yalındağ Öztürk, “Near-Infrared Spectroscopy (NIRS) Monitoring in Pediatric Shock, and The Effect of Fluid Resuscitation on Multisite NIRS Values”, Çocuk Dergisi, c. 24, sy. 3, ss. 136–140, 2025, doi: 10.26650/jchild.2024.1532366.
ISNAD
Aygün, Burcu vd. “Near-Infrared Spectroscopy (NIRS) Monitoring in Pediatric Shock, and The Effect of Fluid Resuscitation on Multisite NIRS Values”. Çocuk Dergisi 24/3 (Ocak 2025), 136-140. https://doi.org/10.26650/jchild.2024.1532366.
JAMA
Aygün B, Incekoy Girgin F, Uyar E, Yalındağ Öztürk N. Near-Infrared Spectroscopy (NIRS) Monitoring in Pediatric Shock, and The Effect of Fluid Resuscitation on Multisite NIRS Values. Çocuk Dergisi. 2025;24:136–140.
MLA
Aygün, Burcu vd. “Near-Infrared Spectroscopy (NIRS) Monitoring in Pediatric Shock, and The Effect of Fluid Resuscitation on Multisite NIRS Values”. Çocuk Dergisi, c. 24, sy. 3, 2025, ss. 136-40, doi:10.26650/jchild.2024.1532366.
Vancouver
Aygün B, Incekoy Girgin F, Uyar E, Yalındağ Öztürk N. Near-Infrared Spectroscopy (NIRS) Monitoring in Pediatric Shock, and The Effect of Fluid Resuscitation on Multisite NIRS Values. Çocuk Dergisi. 2025;24(3):136-40.