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WHEN PAEDIATRIC VITAL SIGNS ARE UNRELIABLE, CONTINUOUS CENTRAL VENOUS OXYGEN SATURATION IS
  1. L C Young1
  1. 1Pediatric Clinical Nurse Consultant, Global Critical Care, Edwards Lifesciences, LLC, Irvine, California, USA

Abstract

Objective Traditional vital sign monitoring in critically ill paediatric patients can be unreliable when it comes to assessing the balance between oxygen delivery and consumption needs. Monitoring central venous oxygen saturation (ScvO2) on a continuous basis provides insights into potential imbalances and early warning that other traditional haemodynamic parameters (heart rate, blood pressure, temperature, central venous pressure and lactate) may miss. Other parameters used for assessing adequate cardiac output and tissue perfusion are largely subjective, such as capillary refill time, temperature changes distal-to-proximal in extremities and skin colour.

Method Literature supports and recommends the use of continuous ScvO2 in the paediatric congenital cardiac surgical patient and in paediatric septic shock.

Results Monitoring ScvO2 levels has been widely accepted and recommended by the ACCM-AHA/PALS septic shock guidelines, and is known to decrease mortality when used continuously as much as 26%. In a case study, continuous ScvO2 indicated a pericardial effusion in a 3-month old infant in which traditional vital signs including lactate levels were unchanged, prompting early response and preventing a potentially life-threatening pericardial tamponade.

Conclusion Incorporating ScvO2 monitoring allows clinicians to identify patients at risk of inadequate balance between oxygen delivery and consumption earlier. Using continuous versus intermittent ScvO2 sampling may also decrease a patient’s risk of infection, the need for transfusion and may be more cost-effective in time and money. In addition, using continuous ScvO2 monitoring in critically ill paediatric patients may be an acceptable surrogate for cardiac output.

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