Effect of Volume Resuscitation on Regional Perfusion in Dehydrated Pediatric Patients as Measured by Two-Site Near-Infrared Spectroscopy

Objective: The aim of this study was to measure the change of cerebral and somatic regional oxygen saturation (rSO(2)) using near-infrared spectroscopic (NIRS) monitoring during volume resuscitation of dehydrated children. Methods: This prospective, observational study enrolled 17 moderately dehydrated children presenting to the emergency department in a tertiary care pediatric hospital. Pulse oximetry and 2-site rSO(2) using forehead and flank NIRS probes were monitored continuously during intravenous rehydration. Results: Prehydration and posthydration data were summarized as mean (SD) and analyzed by paired 2-sided Student t test. Significance was defined as a P < 0.05. Pulse oximetry and cerebral rSO(2) remained unchanged throughout rehydration. The somatic rSO(2) increased from 79% (13) to 87% (9) (P < 0.01) with rehydration, and the somatic-cerebral rSO(2) difference increased from 5% (7) to 13% (6) (P < 0.001). The high-volume rehydration group (33-40 mL/kg) showed a greater increase in somatic rSO(2) with rehydration when compared with the low-volume rehydration group (20 mL/kg). The measured increase in somatic rSO(2) was greatest in children weighing less than 15 kg. Conclusions: In children with acute dehydration, cerebral rSO(2) is preserved in moderate dehydration. Somatic tissue beds show an increase in rSO(2) by NIRS oximetry with rehydration. Two-site NIRS monitoring is a continuous, noninvasive quantitative method for early detection of regional hypoperfusion in dehydrated children.