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
Kaynakça
- Daviaud F, Grimaldi D, Dechartres A, et al. Performance analysis of OFDM modulation on indoor broadband PLC channels. Published online 2011. doi:10.1186/s13613-015-0058-8
- Lima A, Bakker J, Lima A, Bakker · J. Noninvasive monitoring of peripheral perfusion. Intensive Care Med. 2005;31:1316-1326. doi:10.1007/s00134-005-2790-2
- Piasek CZ, Van Bel F, Sola A. Perfusion index in newborn infants: a noninvasive tool for neonatal monitoring. doi:10.1111/apa.12574
- Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med. 2002;30(6):1210-1213. doi:10.1097/00003246-200206000-00006
- Van Genderen ME, Van Bommel J, Lima A. Monitoring peripheral perfusion in critically ill patients at the bedside. Curr Opin Crit Care. 2012;18(3):273-279. doi:10.1097/MCC.0B013E3283533924
- Nishimura T, Nakae A, Shibata M, Mashimo T, Fujino Y. Age-related and sex-related changes in perfusion index in response to noxious electrical stimulation in healthy subjects. J Pain Res. 2014;7:91-97. doi:10.2147/JPR.S57140
- Mowafi HA, Ismail SA, Shafi MA, Al-Ghamdi AA. The efficacy of perfusion index as an indicator for intravascular injection of epinephrine-containing epidural test dose in propofol-anesthetized adults. Anesth Analg. 2009;108(2):549-553. doi:10.1213/ANE.0B013E31818FC35B
- Hu X jing, Ding J xiang, Wang Y, et al. Peripheral perfusion index percentiles for healthy newborns by gestational age and sex in China. Sci Rep. 2020;10(1). doi:10.1038/S41598-020-60741-9
- Sivaprasath P, Mookka Gounder R, Mythili B. Prediction of Shock by Peripheral Perfusion Index. Indian J Pediatr. 2019;86(10):903-908. doi:10.1007/S12098-019-02993-6
- Alakaya M, Arslanköylü AE. Evaluation of perfusion index in pediatric trauma patients. Ulus Travma Acil Cerrahi Derg. 2022 May;28(5):593-598 doi: 10.14744/tjtes.2021.68145
- Bazaraa H, Roby S, Salah E, Algebaly H. Assessment of Tissue Perfusion Using the Peripheral Perfusion Index and Lactate Clearance in Shock in Pediatric Patients. Shock. 2021 Dec 1;56(6):933-938.
- Choudhary VK, Rastogi B, Singh VP, Ghalot S, Dabass V, Ashraf S. Comparison of hemodynamic responses along with perfusion index to tracheal intubation with Macintosh and McCoy laryngoscopes. Int J Res Med Sci. 2018;6(5):1673-1681. doi:10.18203/2320-6012.IJRMS20181757
- Van Genderen ME, Bartels SA, Lima A, et al. Peripheral perfusion index as an early predictor for central hypovolemia in awake healthy volunteers. Anesth Analg. 2013;116(2):351-356. doi:10.1213/ANE.0B013E318274E151
- Hua W, Niu C, Xuan Y, et al. Peripheral perfusion index in well newborns at 6 to 72 h of life at different altitudes: a multi-center study in China. Eur J Pediatr. 2023;182(2):907-915. doi:10.1007/S00431-022-04725-Z
- He H, Long Y, Liu D, Wang X, Zhou X. Clinical classification of tissue perfusion based on the central venous oxygen saturation and the peripheral perfusion index. Crit Care. 2015;19(1). doi:10.1186/S13054-015-1057-8
- De Felice C, Latini G, Vacca P, Kopotic RJ. The pulse oximeter perfusion index as a predictor for high illness severity in neonates. Eur J Pediatr. 2002;161(10):561-562. doi:10.1007/S00431-002-1042-5
- Er MC, Kaya C, Ustun YB, Sahinoglu AH. Predictive value of perfusion index for mortality in mechanically ventilated patients. Aging Male. 2020;23(5):1251-1258. doi:10.1080/13685538.2020.1760816
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
- Daviaud F, Grimaldi D, Dechartres A, et al. Performance analysis of OFDM modulation on indoor broadband PLC channels. Published online 2011. doi:10.1186/s13613-015-0058-8
- Lima A, Bakker J, Lima A, Bakker · J. Noninvasive monitoring of peripheral perfusion. Intensive Care Med. 2005;31:1316-1326. doi:10.1007/s00134-005-2790-2
- Piasek CZ, Van Bel F, Sola A. Perfusion index in newborn infants: a noninvasive tool for neonatal monitoring. doi:10.1111/apa.12574
- Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med. 2002;30(6):1210-1213. doi:10.1097/00003246-200206000-00006
- Van Genderen ME, Van Bommel J, Lima A. Monitoring peripheral perfusion in critically ill patients at the bedside. Curr Opin Crit Care. 2012;18(3):273-279. doi:10.1097/MCC.0B013E3283533924
- Nishimura T, Nakae A, Shibata M, Mashimo T, Fujino Y. Age-related and sex-related changes in perfusion index in response to noxious electrical stimulation in healthy subjects. J Pain Res. 2014;7:91-97. doi:10.2147/JPR.S57140
- Mowafi HA, Ismail SA, Shafi MA, Al-Ghamdi AA. The efficacy of perfusion index as an indicator for intravascular injection of epinephrine-containing epidural test dose in propofol-anesthetized adults. Anesth Analg. 2009;108(2):549-553. doi:10.1213/ANE.0B013E31818FC35B
- Hu X jing, Ding J xiang, Wang Y, et al. Peripheral perfusion index percentiles for healthy newborns by gestational age and sex in China. Sci Rep. 2020;10(1). doi:10.1038/S41598-020-60741-9
- Sivaprasath P, Mookka Gounder R, Mythili B. Prediction of Shock by Peripheral Perfusion Index. Indian J Pediatr. 2019;86(10):903-908. doi:10.1007/S12098-019-02993-6
- Alakaya M, Arslanköylü AE. Evaluation of perfusion index in pediatric trauma patients. Ulus Travma Acil Cerrahi Derg. 2022 May;28(5):593-598 doi: 10.14744/tjtes.2021.68145
- Bazaraa H, Roby S, Salah E, Algebaly H. Assessment of Tissue Perfusion Using the Peripheral Perfusion Index and Lactate Clearance in Shock in Pediatric Patients. Shock. 2021 Dec 1;56(6):933-938.
- Choudhary VK, Rastogi B, Singh VP, Ghalot S, Dabass V, Ashraf S. Comparison of hemodynamic responses along with perfusion index to tracheal intubation with Macintosh and McCoy laryngoscopes. Int J Res Med Sci. 2018;6(5):1673-1681. doi:10.18203/2320-6012.IJRMS20181757
- Van Genderen ME, Bartels SA, Lima A, et al. Peripheral perfusion index as an early predictor for central hypovolemia in awake healthy volunteers. Anesth Analg. 2013;116(2):351-356. doi:10.1213/ANE.0B013E318274E151
- Hua W, Niu C, Xuan Y, et al. Peripheral perfusion index in well newborns at 6 to 72 h of life at different altitudes: a multi-center study in China. Eur J Pediatr. 2023;182(2):907-915. doi:10.1007/S00431-022-04725-Z
- He H, Long Y, Liu D, Wang X, Zhou X. Clinical classification of tissue perfusion based on the central venous oxygen saturation and the peripheral perfusion index. Crit Care. 2015;19(1). doi:10.1186/S13054-015-1057-8
- De Felice C, Latini G, Vacca P, Kopotic RJ. The pulse oximeter perfusion index as a predictor for high illness severity in neonates. Eur J Pediatr. 2002;161(10):561-562. doi:10.1007/S00431-002-1042-5
- Er MC, Kaya C, Ustun YB, Sahinoglu AH. Predictive value of perfusion index for mortality in mechanically ventilated patients. Aging Male. 2020;23(5):1251-1258. doi:10.1080/13685538.2020.1760816
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri (Diğer) |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Erken Görünüm Tarihi | 2 Ocak 2024 |
| Yayımlanma Tarihi | 31 Aralık 2023 |
| Kabul Tarihi | 24 Aralık 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 7 Sayı: 4 |
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