NONINVASIVE MONITORING OF CRITICALLY ILL CHILD

nmcickapak

NONINVASIVE OXYGEN MONITORING IN CRITICALLY ILL CHILD

Didar Arslan1
Çağlar Ödek2

1Bursa Uludağ University, Faculty of Medicine, Department of Pediatric Intensive Care, Bursa, Türkiye
2Bursa Uludağ University, Faculty of Medicine, Department of Pediatric Intensive Care, Bursa, Türkiye

Arslan D, Ödek Ç. Noninvasive Oxygen Monitoring in Critically Ill Child. In: Bal A, editor. Noninvasive Monitoring of Critically Ill Child. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.115-124.

ABSTRACT

Monitoring of oxygenation, which is a critical determinant of morbidity and mortality in critically ill children, is of considerable importance. Compared to invasive monitoring methods, the develop- ment of non-invasive methods has gained momentum in terms of not requiring patient intervention and easy and rapid application. Pulse oximetry measures oxyhemoglobin level in peripheral arterial blood via spectrophotometry. Pulse oximetry can also be used during cardiopulmonary resuscitation,

titrating FiO2 in mechanically ventilated patients, assessing perfusion adequacy and deciding whether to increase or decrease oxygen concentration, or to stop oxygen therapy. Acute respiratory distress syndrome is a condition leading to acute hypoxemic respiratory failure. Diffuse alveolar damage, in-

flammation, capillary endothelial leak, and surfactant deficiency disrupts gas exchange in the lung. Non-cardiac alveolar/pulmonary edema occurs due to epithelial and endothelial damage. Lung compli- ance decreases and severe hypoxia develops. It is one of the leading causes of morbidity and mortality, especially in underdeveloped countries. Determining oxygenation status is essential for treatment. In PALICC-2 guideline published in 2023, mild/moderate and severe classification was introduced for the severity of oxygenation disorder. Similar to the previous guideline, it was recommended to use OI and OSI in patients receiving IMV, and P/F and S/F ratios in patients receiving NIMV. Oxygen therapy should be titrated and accurately monitored to prevent hypoxia and hyperoxia. The most appropriate, non-invasive method used to demonstrate hypoxia is pulse oximetry. However, pulse oximetry does

not give clear information about PaO2. There is no linear relationship between SpO2 and PaO2 due to oxyhemoglobin dissociation curve. SpO2 reaches 100% when PaO2 is ≥80-100 mmHg. When PaO2 continues to increase, no information about PaO2 value can be obtained by pulse oximetry. When the hemoglobin in the arterial blood is fully saturated, i.e., SpO2 ≥97%, arterial blood gas measurement is recommended to determine the oxygenation status. Arterial blood gas measurement is invasive and

repeated samplings are difficult in children. With use of ORI, it seems possible to reoxygenate patients earlier and protect them from hypoxia. ORI, which provides continuous information about PaO2 and shows the development of hypoxia in the patient without decreasing SpO2, can be used for this purpose in emergency services, pediatric intensive care units and operating rooms. ROX index is used as a marker for early detection of HFNCO failure. Although there is no standard definition and cutoff value for the pediatric ROX index, it can be used practically at the bedside to determine the risk of failure in patients receiving HFNCO therapy.

Keywords: Oxygen; Oximetry; Hypoxia; Hyperoxia; Acute respiratory distress syndrome;

Respiratory insufficiency

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