Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants.

摘要: Objectives. Premature infants experience brain injury, ie, germinal matrix–intraventricular hemorrhage (GMH-IVH) and periventricular leukomalacia (PVL), in considerable part because of disturbances cerebral blood flow (CBF). Because such are susceptible to major fluctuations mean arterial pressure (MAP), impaired cerebrovascular autoregulation would increase the likelihood for changes CBF that could result GMH-IVH PVL. The objectives this study were determine whether a state be identified reliably conveniently at bedside, frequency any impairment, relation impairment subsequent occurrence severe Patients Methods. To monitor circulation continuously noninvasively, we used near-infrared spectroscopy (NIRS) quantitative concentrations oxygenated hemoglobin (HbO2) deoxygenated (Hb) from first hours life. Our previous experimental showed strong correlation between measure intravascular oxygenation (HbD), HbD = HbO2 − Hb, determined by NIRS, volemic CBF, radioactive microspheres. We studied 32 very low birth weight premature (gestational age: 23–31 weeks; weight: 605-1870 g) requiring mechanical ventilation, supplemental oxygen, invasive monitoring NIRS 1 3 days age. MAP measured catheter transducer oxygen saturation pulse oximetry recorded simultaneously. relationship was quantitated coherence analysis. Results. Concordant (coherence scores >.5) MAP, consistent with autoregulation, observed 17 (53%). Eight (47%) developed or PVL both. Of 15 apparently intact .5. Conclusions. conclude can noninvasive manner bedside identify is relatively common infants, presence associated high GMH-IVH/PVL.