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PICU: Guarding Against Recovery Risks

Make the PICU a Safer Place to Be

For the critically ill children in your PICU, the road to recovery can be perilous. It is well documented that the initial post-operative hours represent a high-risk period in pediatric cardiac patients. Studies show that silent seizures may be present in up to 25% of infants undergoing circulatory arrest1 and 10% of children experience renal failure.2

In the PICU, the INVOS® System can serve as a vigilant member of your care team, keeping a constant eye on these children to help detect site-specific oxygenation issues that manifest as:
  • Seizures - even those that are clinically "silent" - rSO2 can help identify oxygenation changes that accompany the seizure, reflecting the severity of insult and localizing the side of origin.3,4
  • Low cardiac output - rSO2 tends to decline prior to other indicators such as blood pressure, SaO2 and urine output.5,6 This provides information to assist in averting deterioration into full-blown shock.
  • Shock/splanchnic ischemia - cerebral and somatic rSO2 reflect circulations under very different controls. Differences between them can reflect the relative proportions of peripheral and core blood flow. If somatic peri-renal values are not higher than cerebral values, it may be a potential early indicator of peripheral shut down.5
  • Renal failure - research has described somatic rSO2 values as a more robust post-op indicator of peri-renal perfusion than other hemodynamic parameters, including AGB analysis, SaO2, SvO2, mean blood pressure, central venous pressure, heart rate and PetCO2.7
  • Imbalances in brain-body perfusion - extremely low or high rSO2 may be indicative of circulatory failure or the body's inability to extract oxygen.
  • A more objective method than a "trial and error" approach to ECMO separation - if rSO2 falls significantly during weaning and clamping of the circuit, additional time on ECMO can be ordered. rSO2 can also be used to help navigate the care team's ability to ensure appropriate cannula placement.

    Footnotes:
    1. Newburger JW, et al. N Eng J Med. 1993;329:1057-64.
    2. Nguyen MT, et al. Am J Nephrol. 2005;25:318-26.
    3. Alfonso I, et al. J Child Neurol. 2004; 19:394-6.
    4. Shuhaiber H, et al. J Child Neurol. 2004;19:539-40.
    5. Hoffman GM, et al. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2005;12-21.
    6. Simsic JM. INVOS® Cerebral Oximeter Clinical White Paper Series. 2005;412(1):1-4.
    7. Hoffman GM, et al. Anesthesiology. 2005;103:A1327.