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Oxymétrie pulsée : contribution au diagnostic et à l’approche hémodynamique en pédiatrie

Pulse oximetry: a tool for diagnosis and hemodynamic assessment in pediatrics

  • Session Thématique en Réanimation Pédiatrique
  • Published:
Réanimation

Résumé

L’oxymétrie de pouls est utilisée en pédiatrie depuis presque 30 ans, pour surveiller la fonction respiratoire et ajuster l’oxygénothérapie. Des avancées technologiques dans le traitement du signal pléthysmographique suggèrent un intérêt potentiel pour l’évaluation hémodynamique. L’indice de perfusion périphérique (IP), qui évalue le contingent pulsatile du signal, est proposé comme indicateur continu et non invasif de la circulation distale. Son utilisation clinique a surtout été développée en néonatalogie, comme aide au diagnostic ou complément à l’exploration de la macrocirculation. Dans la perspective d’un dépistage de cardiopathie, une valeur seuil < 0,70 est évocatrice d’une obstruction critique sur la voie d’éjection ventriculaire gauche. Chez le nouveau-né prématuré, plusieurs observations soulignent sa pertinence pour le diagnostic de bas débit systématique ou de persistance du canal artériel. Les indices dérivés de la variabilité respiratoire de la pléthysmographie de l’oxymètre ont fait principalement l’objet de travaux chez l’enfant, au bloc opératoire, dans la perspective d’évaluer sa volémie et de prédire sa réponse au remplissage vasculaire. Cependant, les résultats sont contradictoires et ne permettent actuellement pas, dans ce contexte, de rationaliser l’administration de fluides avec fiabilité par l’utilisation de ces paramètres. Des études supplémentaires sont nécessaires, particulièrement en réanimation pédiatrique, pour démontrer que l’oxymétrie de pouls peut être un outil hémodynamique d’une validité comparable à celle établie en médecine intensive de l’adulte.

Abstract

Since more than 30 years, pulse oximetry is used in pediatrics to monitor respiratory function and adjust oxygen therapy. Advances in signal processing of plethysmographic curves may confer additional interest for hemodynamic evaluation. The perfusion index (PI) deriving from pulse oxymetry and quantifying the pulsatile component of the signal has been proposed as continuous and noninvasive indicator of distal vessel function. The clinical practice with this index has mainly been developed in neonates. In the context of congenital heart disease screening, a value of < 0.70 may indicate critical left heart obstruction. In premature neonates, observations also suggest that PI may be relevant to diagnose low systemic outpout or persistent ductus arteriosus. Indices derived from respiratory variations of pulse oximeter plethysmograph amplitude have been mainly tested in children before or during surgery, to assess volemia and predict fluid responsiveness in the operating room. However, the currently debated data based on these indices may still not allow their use to guide reliable fluid administration. Further studies are required, particularly in children hospitalized in the intensive care unit, to demonstrate that pulse oximetry is an accurate hemodynamic tool, as clearly established in adults.

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Authors and Affiliations

  1. Département de pédiatrie néonatale et réanimations, pôle hospitalo-universitaire enfant, CHRU de Montpellier, F-34000, Montpellier, France

    S. Durand, J. Baleine, J. Le Bouhellec, C. Milési, R. Mesnage & G. Cambonie

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  1. S. Durand
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  2. J. Baleine
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  3. J. Le Bouhellec
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  4. C. Milési
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  5. R. Mesnage
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  6. G. Cambonie
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Correspondence to G. Cambonie.

Additional information

Cet article correspond à la conférence faite par l’auteur au congrès de la SRLF 2015 dans la session : Marqueurs de décompensation.

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Durand, S., Baleine, J., Le Bouhellec, J. et al. Oxymétrie pulsée : contribution au diagnostic et à l’approche hémodynamique en pédiatrie. Réanimation 24 (Suppl 2), 322–331 (2015). https://doi.org/10.1007/s13546-014-1004-8

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  • DOI: https://doi.org/10.1007/s13546-014-1004-8

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