Monitoring of O2 transport and tissue oxygenation in paediatric critical care

Maintenance of adequate tissue oxygenation is the cardinal principle of critical care medicine. While in adults (and older children) monitoring of 0, transport and tissue oxygenation is now widely used, the experience in monitoring of the oxygen transport system in paediatric critical care is still rather limited, especially in neonates and infants. This may be attributed in part to the fact that in monitoring critically ill children, one must consider wider variations in size, age, and physiology and tailor the techniques to meet these characteristics. Until a few years ago, measurement of oxygenation in critically ill infants was essentially limited to arterial blood sampling. This approach fails to describe fully the relationship of oxygen supply and consumption and therefore does not allow clear assessment of adequate tissue oxygenation. Conventional methods of monitoring the arterial oxygen content have had little effect on the incidence of retinopathy of prematurity or the survival of low birth weight infants (Kirisey e f k. 1977; Bancalari et al. 1987). Improving tissue oxygenation by increasing oxygen delivery (e.g. by increasing cardiac output) in critically ill adult patients, including those in septic shock can improve outcome (Edwards et al. 1989; Tuchschmidt et al. 1992) provides a strong argument in favour of monitoring the O2 transport system in infants as well. Therefore, attempts have

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