1
|
Marini CP, McNelis J, Petrone P. Multimodality Monitoring and Goal-Directed Therapy for the Treatment of Patients with Severe Traumatic Brain Injury: A Review for the General and Trauma Surgeon. Curr Probl Surg 2021; 59:101070. [DOI: 10.1016/j.cpsurg.2021.101070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
|
2
|
Marini CP, McNelis J, Petrone P. In Brief. Curr Probl Surg 2021. [DOI: 10.1016/j.cpsurg.2021.101071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
3
|
Patchana T, Wiginton J, Brazdzionis J, Ghanchi H, Zampella B, Toor H, Dorkoski R, Mannickarottu A, Wacker M, Sweiss R, Miulli DE. Increased Brain Tissue Oxygen Monitoring Threshold to Improve Hospital Course in Traumatic Brain Injury Patients. Cureus 2020; 12:e7115. [PMID: 32257661 PMCID: PMC7101240 DOI: 10.7759/cureus.7115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction This article is a retrospective analysis of the neurosurgical census at our institution to determine an optimal threshold for brain tissue oxygenation (PbtO2). The use of brain tissue oxygen monitoring has been in place for approximately three decades but data suggesting optimal thresholds to improve outcomes have been lacking. Though there are multiple modalities to monitor cerebral oxygenation, the monitoring of brain tissue oxygen tension has been deemed the gold standard. Still, it is not clear exactly how reductions in PbtO2 should be treated or what appropriate thresholds to treat might be. The aim of our study was to determine if our threshold of 28 mmHg for a good functional outcome could be correlated to the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS). Methods A retrospective analysis of the Arrowhead Regional Medical Center (ARMC) Neurosurgery Census was performed. Patients from 2017-2019 who had placement of Licox® cerebral oxygen monitoring sensors (Integra® Lifesciences, Plainsboro Township, New Jersey) were included in the analysis. Fifteen patients were consecutively identified, all of which presented with traumatic brain injury (TBI). Data on age, gender, days in the intensive care unit (ICU), days before discharge or end of medical care, admission GCS, hospital length of stay, GOS, maximum and minimum PbtO2 values for five days following insertion, minimum and maximum intracranial pressures (ICPs), and brain temperature were included for analysis. Patient data were separated into two groups; those with consistently higher PbtO2 scores (≥ 28 mmHg; n = 7) and those with inconsistent/lower PbtO2 scores (< 28 mmHg; n = 8). Standard student t-tests were used to find potential statistical differences between the groups (α = 0.05). Results There were seven patients in the consistently high PbtO2 category (≥ 28 mmHg) and eight patients in the inconsistent/low PbtO2 category (<28 mmHg). The average maximum and minimum PbtO2 for the group displaying worse outcomes (as defined by GCS/GOS) was 23.0 mmHg and 14 mmHg, respectively. Those with consistent Day 2 PbtO2 scores of ≥ 28 mmHg had significantly higher GCS scores at discharge/end of medical care (p < 0.05). Average GCS for the patient group with >28 mmHg PbtO2 averaged over Days 2-5 group was 11.4 (n=7). Average GCS for the <28 group was 7.0 (n=8). The GCS for the >28 group was 63% higher than found in the <28 group (p = 0.03). GOS scores were significantly higher in those with consistently higher PbtO2 (≥ 28) than those with lower PbtO2 scores (< 28). The averages were 3.5 in the higher PbtO2 group as compared to 2 in the lower PbtO2 group. Conclusion Along with ICP monitors and monitoring in the assessment of CPP, brain tissue oxygenation allows yet another metric by which to optimize treatment in TBI patients. At our institution, a PbtO2 level of ≥ 28 mmHg is targeted in order to facilitate a good functional outcome in TBI patients. Keeping patients at this level improves GCS and GOS at discharge/end of medical treatment.
Collapse
Affiliation(s)
- Tye Patchana
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James Wiginton
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James Brazdzionis
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Hammad Ghanchi
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Bailey Zampella
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Harjyot Toor
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Ryan Dorkoski
- Environmental and Plant Science, Ohio University, Athens, USA
| | | | - Margaret Wacker
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
| | - Raed Sweiss
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Dan E Miulli
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| |
Collapse
|
4
|
Muthuchellappan R, Shaikh NA, Surve RM, Ganne URS, Philip M. Regional cerebral tissue oxygen saturation changes following blood transfusion in neuro-intensive care unit patients - a pilot observational study. Transfus Med 2018; 28:304-309. [PMID: 29318718 DOI: 10.1111/tme.12504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although central venous oxygen saturation (ScvO2 ) is used to decide on red blood cell (RBC) transfusion, whether its improvement is associated with parallel improvement in cerebral oxygenation is not adequately studied. This study looked at changes in regional cerebral tissue oxygen saturation (rSO2 ) following RBC transfusion in neuro-intensive care unit (ICU) patients. METHODS In this prospective observational pilot study, rSO2 was measured in adult neuro-ICU patients before RBC transfusion, at the end and at 6, 12, 18 and 24 h after RBC transfusion. rSO2 measurements were taken using cerebral oximetry on both sides of the hemicraniums. Haemoglobin, central venous pressure, ScvO2 and temperature were recorded during the study period. Arterial oxygen content, central venous oxygen content and cerebral fractional oxygen extraction were calculated. Mann Whitney U test was used to study the changes in variables at baseline and at 24 h following RBC transfusion. Friedman's test was used to study changes in parameters from baseline to 24 h post-transfusion. A P value of <0·05 was considered to be significant. RESULTS The data from 13 subjects were analysed. rSO2 increased significantly following RBC transfusion on both sides of the brain (P = 0·002, P = 0·007), with a corresponding decrease in cerebral fractional oxygen extraction (P = 0·001, P = 0·007). CONCLUSIONS RBC transfusion increased rSO2 significantly on both sides of the brain. As patients' outcomes were not studied, whether this increase in regional cerebral oxygen saturation is beneficial or if it is because of excess DO2 is still unclear. Further studies are required to clarify this issue.
Collapse
Affiliation(s)
- R Muthuchellappan
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru, India
| | - N A Shaikh
- Department of Anaesthesiology and Critical Care, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - R M Surve
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru, India
| | - U R S Ganne
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru, India
| | - M Philip
- Department of Biostatistics, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru, India
| |
Collapse
|
5
|
Weigl W, Milej D, Janusek D, Wojtkiewicz S, Sawosz P, Kacprzak M, Gerega A, Maniewski R, Liebert A. Application of optical methods in the monitoring of traumatic brain injury: A review. J Cereb Blood Flow Metab 2016; 36:1825-1843. [PMID: 27604312 PMCID: PMC5094301 DOI: 10.1177/0271678x16667953] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/28/2016] [Accepted: 07/18/2016] [Indexed: 01/19/2023]
Abstract
We present an overview of the wide range of potential applications of optical methods for monitoring traumatic brain injury. The MEDLINE database was electronically searched with the following search terms: "traumatic brain injury," "head injury," or "head trauma," and "optical methods," "NIRS," "near-infrared spectroscopy," "cerebral oxygenation," or "cerebral oximetry." Original reports concerning human subjects published from January 1980 to June 2015 in English were analyzed. Fifty-four studies met our inclusion criteria. Optical methods have been tested for detection of intracranial lesions, monitoring brain oxygenation, assessment of brain perfusion, and evaluation of cerebral autoregulation or intracellular metabolic processes in the brain. Some studies have also examined the applicability of optical methods during the recovery phase of traumatic brain injury . The limitations of currently available optical methods and promising directions of future development are described in this review. Considering the outstanding technical challenges, the limited number of patients studied, and the mixed results and opinions gathered from other reviews on this subject, we believe that optical methods must remain primarily research tools for the present. More studies are needed to gain confidence in the use of these techniques for neuromonitoring of traumatic brain injury patients.
Collapse
Affiliation(s)
- Wojciech Weigl
- Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, Akademiska Hospital, Uppsala, Sweden
| | - Daniel Milej
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Dariusz Janusek
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Stanisław Wojtkiewicz
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Piotr Sawosz
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Michał Kacprzak
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Anna Gerega
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Roman Maniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Adam Liebert
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| |
Collapse
|
6
|
Mikkelsen MLG, Ambrus R, Miles JE, Poulsen HH, Moltke FB, Eriksen T. Effect of propofol and remifentanil on cerebral perfusion and oxygenation in pigs: a systematic review. Acta Vet Scand 2016; 58:42. [PMID: 27334375 PMCID: PMC4917978 DOI: 10.1186/s13028-016-0223-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/13/2016] [Indexed: 12/09/2022] Open
Abstract
The objective of this review is to evaluate the existing literature with regard to the influence of propofol and remifentanil total intravenous anaesthesia (TIVA) on cerebral perfusion and oxygenation in healthy pigs. Anaesthesia has influence on cerebral haemodynamics and it is important not only in human but also in veterinary anaesthesia to preserve optimal regulation of cerebral haemodynamics. Propofol and remifentanil are widely used in neuroanaesthesia and are increasingly used in experimental animal studies. In translational models, the pig has advantages compared to small laboratory animals because of brain anatomy, metabolism, neurophysiological maturation, and cerebral haemodynamics. However, reported effects of propofol and remifentanil on cerebral perfusion and oxygenation in pigs have not been reviewed. An electronic search identified 99 articles in English. Title and abstract screening selected 29 articles for full-text evaluation of which 19 were excluded with reasons. Of the 10 peer-reviewed articles included for review, only three had propofol or remifentanil anaesthesia as the primary study objective and only two directly investigated the effect of anaesthesia on cerebral perfusion and oxygenation (CPO). The evidence evaluated in this systematic review is limited, not focused on propofol and remifentanil and possibly influenced by factors of potential importance for CPO assessment. In one study of healthy pigs, CPO measures were within normal ranges following propofol-remifentanil anaesthesia, and addition of a single remifentanil bolus did not affect regional cerebral oxygen saturation (rSO2). Even though the pool of evidence suggests that propofol and remifentanil alone or in combination have limited effects on CPO in healthy pigs, confirmative evidence is lacking.
Collapse
Affiliation(s)
| | - Rikard Ambrus
- Department of Surgical Gastroenterology C, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, 2100 Copenhagen Ø, Denmark
| | - James Edward Miles
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, 16 Dyrlægevej, 1870 Frederiksberg C, Denmark
| | - Helle Harding Poulsen
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, 16 Dyrlægevej, 1870 Frederiksberg C, Denmark
| | - Finn Borgbjerg Moltke
- Department of Neuroanaesthesia, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, 2100 Copenhagen Ø, Denmark
- Department of Anaesthesia, Sealand Hospital, University of Copenhagen, 1 Lykkebækvej, 4600 Køge, Denmark
| | - Thomas Eriksen
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, 16 Dyrlægevej, 1870 Frederiksberg C, Denmark
| |
Collapse
|
7
|
Feasibility of near-infrared spectroscopic tomography for intraoperative functional cerebral monitoring: a primate study. J Thorac Cardiovasc Surg 2014; 148:3204-10.e1-2. [PMID: 25439529 DOI: 10.1016/j.jtcvs.2014.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/02/2014] [Accepted: 07/13/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The wide-ranging manipulations to the cardiovascular system that frequently occur during cardiac surgery can expose the brain to variations in its blood supply that could prove deleterious. As a first step to developing a resource suitable for monitoring such changes, we detected the hemodynamic events induced in the brain of a primate model, using high-density near-infrared spectroscopy combined with tomographic reconstruction methods and validated the findings using established radiologic and histologic techniques. METHODS Continuous monitoring of the relative changes in the components of the cerebral hemoglobin signal was performed using high-density near-infrared spectroscopy (270 source-detector channel array) in anesthetized bonnet macaques with the brain exposed to induced ischemia and other acute events. A comparative analysis (exact binomial test) applied to reconstructed 3-dimensional images before and after the events and between cerebral hemispheres, combined with postprocedure magnetic resonance imaging, and postmortem histopathologic examination of the macaques' brains was performed to document and validate the spatial features revealed by the optical findings. RESULTS Relative changes in the measured and calculated components of the hemoglobin signal, in response to the performed manipulations, revealed substantial concurrence among the reconstructed 3-dimensional images, magnetic resonance imaging of the macaques' brains, and postmortem histopathologic examination findings. Concurrence was seen when the manipulated hemoglobin concentration and associated oxygenation levels were either increased or decreased, and whether they were bilateral or restricted to a specified hemisphere. CONCLUSIONS Continuous near-infrared spectroscopy tomography has been shown to accurately capture and localize cerebral ischemia, vasodilatation, and hemorrhage in primates in real time. These findings are directly applicable to clinical intraoperative functional cerebral monitoring.
Collapse
|
8
|
Salazar D, Sears BW, Andre J, Tonino P, Marra G. Cerebral desaturation during shoulder arthroscopy: a prospective observational study. Clin Orthop Relat Res 2013; 471:4027-34. [PMID: 23604602 PMCID: PMC3825914 DOI: 10.1007/s11999-013-2987-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 04/08/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients undergoing arthroscopic shoulder surgery in the beach chair position may be at increased risk for serious neurocognitive complications as a result of cerebral ischemia. QUESTIONS/PURPOSES We sought to define the (1) incidence; (2) timing; and (3) magnitude of intraoperative cerebral desaturation events (CDEs) in subjects undergoing arthroscopic shoulder surgery in the beach chair position, as well as whether (4) the length of surgery was an independent risk factor for intraoperative CDEs. METHODS Regional cerebral tissue oxygen saturation (rSO2) was monitored intraoperatively using near-infrared spectroscopy on 51 consecutive patients undergoing arthroscopic shoulder surgery in the beach chair position. Intraoperative decreases in rSO2 of 20% or greater were defined as CDEs. RESULTS The incidence of intraoperative CDEs in our series was 18% (nine of 51). Among the patients demonstrating CDE (n = 9), the mean time to onset of initial CDE was 18 minutes 38 seconds postinduction. Of those experiencing CDEs, the mean maximal decrease in rSO2 was 32% from preoperative baseline per patient. Additionally, the mean number of separate CDE instances was 1.89 in this patient population with an average duration of 3 minutes 3 seconds per instance. There was no statistically significant difference (p = 0.202) between patients demonstrating CDEs and those without in regard to length of surgery (95 versus 88 minutes). CONCLUSIONS The degree and duration of cerebral ischemia required to produce neurocognitive dysfunction in this patient population remains undefined; however, cerebral oximetry with near-infrared spectroscopy allows prompt identification and treatment of decreased cerebral perfusion. We believe protocols aimed at detecting and reversing CDE may improve patient safety.
Collapse
Affiliation(s)
- Dane Salazar
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, 2160 South First Avenue, Maywood, IL, 60153, USA,
| | | | | | | | | |
Collapse
|
9
|
Lee EH, Choi E, Ahn W. Application of cerebral oximetry for a parturient with Takayasu's arteritis undergoing cesarean section -a case report-. Korean J Anesthesiol 2013; 65:158-62. [PMID: 24024000 PMCID: PMC3766783 DOI: 10.4097/kjae.2013.65.2.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 09/10/2012] [Accepted: 09/20/2012] [Indexed: 11/16/2022] Open
Abstract
Takayasu's arteritis (TA) is a chronic inflammatory disease involving the aorta. Because TA sometimes involves cerebral arteries, anesthetic debates focus on cerebral monitoring. There is limited evidence as to which cerebral monitoring method is most adequate. Furthermore, there is insufficient evidence to determine which anesthetic technique is better for TA parturients. We experienced the case of a TA parturient who developed transient cerebral ischemia during cesarean section. The patient's TA involved her cerebral arteries, and her regional cerebral oxygen saturation (rSO2) was lower in the left side than in the right side. She complained of speech impairment, tinnitus, and stiffness of the posterior neck when the rSO2 levels dropped. The FloTrac/Vigileo™ system did not correlate with clinical symptoms, but the cerebral oximeter displayed the low oxygen saturation. We recommend the cerebral oximetry for cerebral monitoring in TA parturients who undergo cesarean sections, especially in hemodynamically unstable patients under regional anesthesia or unconscious patients under general anesthesia.
Collapse
Affiliation(s)
- Eun Hye Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | | | | |
Collapse
|
10
|
Salazar D, Sears BW, Aghdasi B, Only A, Francois A, Tonino P, Marra G. Cerebral desaturation events during shoulder arthroscopy in the beach chair position: patient risk factors and neurocognitive effects. J Shoulder Elbow Surg 2013; 22:1228-35. [PMID: 23415820 DOI: 10.1016/j.jse.2012.12.036] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 12/06/2012] [Accepted: 12/14/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients undergoing shoulder surgery in the beach chair position may be at increased risk for serious neurocognitive complications due to cerebral ischemia. We sought to define the incidence, patient risk factors, and clinical sequelae of intraoperative cerebral desaturation events. METHODS Regional cerebral tissue oxygen saturation (rSO2) was monitored intra-operatively using near-infrared spectroscopy (NIRS) on 50 consecutive patients. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was administered to each patient pre- and postoperatively. Intra-operative decreases in rSO2 of 20% or greater were defined as cerebral desaturation events (CDE). The association between intraoperative CDE and postoperative cognitive decline was assessed. RESULTS The incidence of intraoperative CDE in our series was 18% (9/50). Increased body mass index (BMI) was found to have a statistically significant association with intraoperative CDE (mean BMI 37.32 vs 28.59, P < .0001). There was no statistical significance in pre- vs postoperative RBANS either in composite scores or any of the sub-indices in either group. CONCLUSION The degree and duration of cerebral ischemia required to produce neurocognitive dysfunction in this patient population remains undefined; however, cerebral oximetry with NIRS allows prompt identification and treatment of decreased cerebral perfusion decreasing the risk of this event. Increased BMI was found to be a statistically significant patient risk factor for the development of intra-operative CDE. The transient intra-operative CDEs were not associated with postoperative cognitive dysfunction in our patient series. We believe protocols aimed at detecting and reversing CDE minimize the risk of neurocognitive dysfunction and improve patient safety.
Collapse
Affiliation(s)
- Dane Salazar
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL 60153, USA.
| | | | | | | | | | | | | |
Collapse
|
11
|
Choi SH, Kim SH, Lee SJ, Soh SR, Oh YJ. Cerebral oxygenation during laparoscopic surgery: jugular bulb versus regional cerebral oxygen saturation. Yonsei Med J 2013; 54:225-30. [PMID: 23225824 PMCID: PMC3521259 DOI: 10.3349/ymj.2013.54.1.225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We hypothesized that regional cerebral oxygen saturation (rSO2) could replace jugular bulb oxygen saturation (SjvO2) in the steep Trendelenburg position under pneumoperitoneum. Therefore, we evaluated the relationship between SjvO2 and rSO2 during laparoscopic surgery. MATERIALS AND METHODS After induction of anesthesia, mechanical ventilation was controlled to increase PaCO2 from 35 to 45 mm Hg in the supine position, and the changes in SjvO2 and rSO2 were measured. Then, after establishment of pneumoperitoneum and Trendelenburg position, ventilation was controlled to maintain a PaCO2 at 35 mm Hg and the CO2 step and measurements were repeated. The changes in SjvO2 (rSO2) -CO2 reactivity were compared in the supine position and Trendelenburg-pneumoperitoneum condition, respectively. RESULTS There was little correlation between SjvO2 and rSO2 in the supine position (concordance correlation coefficient=0.2819). Bland-Altman plots showed a mean bias of 8.4% with a limit of agreement of 21.6% and -4.7%. SjvO2 and rSO2 were not correlated during Trendelenburg-pneumoperitoneum condition (concordance correlation coefficient=0.3657). Bland-Altman plots showed a mean bias of 10.6% with a limit of agreement of 23.6% and -2.4%. The SjvO2-CO2 reactivity was higher than rSO2-CO2 reactivity in the supine position and Trendelenburg- pneumoperitoneum condition, respectively (0.9 ± 1.1 vs. 0.4 ± 1.2% mm Hg(-1), p=0.04; 1.7 ± 1.3 vs. 0.5 ± 1.1% mm Hg(-1), p<0.001). CONCLUSION There is little correlation between SjvO2 and rSO2 in the supine position and Trendelenburg-pneumoperitoneum condition during laparoscopic surgery.
Collapse
Affiliation(s)
- Seung Ho Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Hwan Kim
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung Jin Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sa Rah Soh
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Jun Oh
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
12
|
Song JG, Jeong SM, Shin WJ, Jun IG, Shin K, Huh IY, Kim YK, Hwang GS. Laboratory Variables Associated with Low Near-Infrared Cerebral Oxygen Saturation in Icteric Patients Before Liver Transplantation Surgery. Anesth Analg 2011; 112:1347-52. [DOI: 10.1213/ane.0b013e318214b2b0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
13
|
Harilall Y, Adam JK, Biccard BM, Reddi A. Correlation between cerebral tissue and central venous oxygen saturation during off-pump coronary bypass graft surgery. Perfusion 2010; 26:83-90. [PMID: 21078769 DOI: 10.1177/0267659110387846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We compared simultaneous regional cerebral oxygen saturation and central venous oxygen saturation at different time periods in 20 adult patients (median age, 57.9; range, 35 to 76 years) undergoing off-pump coronary artery bypass (OPCAB) graft surgery (n= 20). Mean arterial pressure (MAP), partial pressure of carbon dioxide (PcvCO(2)), heart rate, haematocrit (Hct), lactate and patient oxygen saturation (SpO(2)) were also recorded as a secondary analysis to determine independent predictors of cerebral desaturation and interactions between predictors. The cross-sectional analysis performed at each time point showed several significant moderate to strong positive correlations between central venous oxygen saturation and both right and left cerebral oxygen saturations; however, right cerebral saturations correlated better with central venous saturations than left cerebral saturation. Partial pressure of carbon dioxide (PcvCO(2)) was identified as a major predictor of cerebral saturation 0.59 (p < 0.001). Central venous saturation can be used as a surrogate measure of cerebral oxygen saturation during OPCAB surgery.
Collapse
Affiliation(s)
- Yakeen Harilall
- Dept of Cardiothoracic Surgery, Inkosi Albert Luthuli Central Hospital, KZN, South Africa
| | | | | | | |
Collapse
|
14
|
Nguyen L, Banks D, Madani M, Bulatao J. CASE 6—2009 Anesthetic Implications of Partial Left-Heart Bypass for Repair of the Descending Thoracic Aorta. J Cardiothorac Vasc Anesth 2009; 23:893-900. [DOI: 10.1053/j.jvca.2009.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Indexed: 11/11/2022]
|
15
|
Choi SH, Lee SJ, Rha KH, Shin SK, Oh YJ. The effect of pneumoperitoneum and Trendelenburg position on acute cerebral blood flow-carbon dioxide reactivity under sevoflurane anaesthesia. Anaesthesia 2008; 63:1314-8. [PMID: 19032299 DOI: 10.1111/j.1365-2044.2008.05636.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study compared cerebral blood flow-carbon dioxide (CBF-CO2) reactivities in the supine and modest Trendelenburg position under pnemoperitoneum during sevoflurane anaesthesia. After induction of anaesthesia in 25 patients, mechanical ventilation was adjusted to increase Paco2 from 4.7 (T1) to 6.0 kPa (T2) in the supine position, and the change in jugular bulb oxygen saturation was measured as an index of CBF. Then, after establishment of pneumoperitoneum and 30 degrees Trendelenburg position, the CO(2) step and measurement of CBF were repeated. The CBF-CO2 reactivity was 7.5 (3.3) %xkPa(-1) (% change in jugular bulb oxygen saturation per unit change in Paco2) in the supine position and 6.8 (2.3) %xkPa(-1) in the 30 degrees Trendelenburg-pneumoperitoneum condition (p = 0.086). We conclude that CBF-CO2 reactivity is unchanged by the modest Trendelenburg position under pneumoperitoneum during sevoflurane anaesthesia.
Collapse
Affiliation(s)
- S H Choi
- Department of Anaesthesiology and PAin medicine, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
16
|
Chakravarti S, Srivastava S, Mittnacht AJC. Near Infrared Spectroscopy (NIRS) in Children. Semin Cardiothorac Vasc Anesth 2008; 12:70-9. [DOI: 10.1177/1089253208316444] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Near infrared spectroscopy (NIRS) is a noninvasive method for the in vivo monitoring of tissue oxygenation. Originally used predominantly to assess cerebral oxygenation, NIRS has gained widespread popularity in many clinical settings in all age groups. Changes in regional tissue oxygenation as detected by NIRS may reflect the delicate balance between oxygen delivery and consumption in more than one organ system. However, more studies are required to establish the ability of NIRS monitoring to improve patient outcome. This review provides a comprehensive description of NIRS in children.
Collapse
|
17
|
Hoffman GM. Neurologic monitoring on cardiopulmonary bypass: what are we obligated to do? Ann Thorac Surg 2007; 81:S2373-80. [PMID: 16731106 DOI: 10.1016/j.athoracsur.2006.02.076] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 01/17/2006] [Accepted: 02/04/2006] [Indexed: 11/18/2022]
Abstract
Improving survival from congenital cardiac repairs using cardiopulmonary bypass has appropriately shifted focus to neurologic outcomes. Hypoxic-ischemic mechanisms are the major cause of neurologic injury in neonatal cardiac surgery, and modifications of techniques of cardiopulmonary bypass can affect organ oxygen delivery and the propensity to injury both during and after surgery. Through successive refinements in the techniques of cardiopulmonary bypass, the risk factors for hypoxic-ischemic injury have been reduced, but not eliminated. The application of specific monitoring to enhance detection of hypoxic conditions associated with neurologic injury would both allow intervention on individual patients and drive refinements in strategies to further reduce risk. Specific neurologic monitoring techniques that can be used during cardiopulmonary bypass include near-infrared spectroscopy, transcranial Doppler ultrasonography, and electroencephalographic techniques. Of these, only near-infrared spectroscopy provides a continuous quantitative signal of the physiologic variable most related to injury and most amenable to intervention. This review will advocate wide adoption of near-infrared spectroscopy monitoring throughout the perioperative period, to enhance detection of hypoxic conditions and to drive patient-specific interventions.
Collapse
MESH Headings
- Brain Damage, Chronic/etiology
- Brain Damage, Chronic/physiopathology
- Brain Damage, Chronic/prevention & control
- Cardiopulmonary Bypass/adverse effects
- Electroencephalography
- Extracorporeal Membrane Oxygenation
- Hemoglobinometry/instrumentation
- Hemoglobinometry/methods
- Humans
- Hypoxia/diagnosis
- Hypoxia/etiology
- Hypoxia/physiopathology
- Hypoxia-Ischemia, Brain/diagnosis
- Hypoxia-Ischemia, Brain/diagnostic imaging
- Hypoxia-Ischemia, Brain/etiology
- Hypoxia-Ischemia, Brain/physiopathology
- Hypoxia-Ischemia, Brain/prevention & control
- Infant
- Infant, Newborn
- Intracranial Embolism/diagnosis
- Intracranial Embolism/etiology
- Intracranial Embolism/physiopathology
- Intracranial Embolism/prevention & control
- Intraoperative Complications/diagnosis
- Intraoperative Complications/etiology
- Intraoperative Complications/physiopathology
- Intraoperative Complications/prevention & control
- Magnetic Resonance Imaging
- Monitoring, Intraoperative
- Oxyhemoglobins/analysis
- Postoperative Complications/diagnosis
- Postoperative Complications/etiology
- Postoperative Complications/physiopathology
- Postoperative Complications/prevention & control
- Risk Factors
- Spectroscopy, Near-Infrared/methods
- Spectroscopy, Near-Infrared/standards
- Ultrasonography, Doppler, Transcranial
Collapse
Affiliation(s)
- George M Hoffman
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
| |
Collapse
|
18
|
McDonagh DL, McDaniel MR, Monk TG. The effect of intravenous indigo carmine on near-infrared cerebral oximetry. Anesth Analg 2007; 105:704-6. [PMID: 17717227 DOI: 10.1213/01.ane.0000271917.20429.50] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The effects of IV-administered dyes on pulse oximetry have been well described. However, the effects on near-infrared cerebral oximetry have not been well documented. We report a series of four patients undergoing radical prostatectomy who were monitored with cerebral oximetry during surgery. After the administration of indigo carmine, intraoperative desaturations were observed for an extended period. Because clinical use of near-infrared cerebral oximetry is increasing, anesthesiologists should be aware of this issue.
Collapse
Affiliation(s)
- David L McDonagh
- Department of Anesthesiology, Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina 27710, USA.
| | | | | |
Collapse
|
19
|
Abstract
Neurological complications during critical illness remain a frequent cause of morbidity and mortality. To date, monitors of cerebral function including electroencephalography, jugular bulb mixed venous oxygen saturation and transcranial Doppler, either require an invasive procedure and/or are not sensitive enough to effectively identify patients at risk for cerebral hypoxia. Near-infrared spectroscopy is a noninvasive device that uses infrared light, a technique similar to pulse oximetry, to penetrate living tissue and estimate brain tissue oxygenation by measuring the absorption of infrared light by tissue chromophores. The following article reviews the latest technology available to monitor cerebral oxygenation, near-infrared spectroscopy, its advantages and disadvantages, the currently available evidence-based medicine that demonstrates that this technology can identify deficits in cerebral oxygenation, and that monitoring such deficits allows for therapy to reverse cerebral oxygenation issues and thereby prevent long-term neurological sequelae.
Collapse
Affiliation(s)
- Joseph D Tobias
- Department of Anesthesiology, University of Missouri, Columbia, MO 65212, USA.
| |
Collapse
|
20
|
Davies LK, Janelle GM. Con: All Cardiac Surgical Patients Should Not Have Intraoperative Cerebral Oxygenation Monitoring. J Cardiothorac Vasc Anesth 2006; 20:450-5. [PMID: 16750752 DOI: 10.1053/j.jvca.2006.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Indexed: 11/11/2022]
Affiliation(s)
- Laurie K Davies
- Department of Anesthesiology, Box 100254, 1600 SW Archer Road, University of Florida, Gainesville, 32610, USA.
| | | |
Collapse
|
21
|
Rigamonti A, Scandroglio M, Minicucci F, Magrin S, Carozzo A, Casati A. A clinical evaluation of near-infrared cerebral oximetry in the awake patient to monitor cerebral perfusion during carotid endarterectomy. J Clin Anesth 2006; 17:426-30. [PMID: 16171662 DOI: 10.1016/j.jclinane.2004.09.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2003] [Accepted: 09/09/2004] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To evaluate the relationship between continuous noninvasive monitoring of cerebral saturation (regional cerebral oxygen saturation [rSo2]) and occurrence of clinical and electroencephalographic (EEG) signs of cerebral ischemia during carotid cross-clamping. DESIGN Prospective clinical study. SETTING University hospital. PATIENTS Fifty ASA physical status II and III inpatients undergoing elective carotid endarterectomy with a cervical plexus block. INTERVENTIONS rSo2 was continuously monitored throughout surgery, while an independent neurologist evaluated the occurrence of both clinical and EEG signs of cerebral ischemia induced during carotid cross-clamping. MEASUREMENTS AND MAIN RESULTS rSo2 was recorded 1 and 3 minutes after clamping the carotid artery during a 3-minute clamping test. In 5 patients (10%), the carotid clamping test was associated with the occurrence of clinical and EEG signs of cerebral ischemia. All these patients were treated with the placement of a Javid shunt, which completely resolved the symptoms. In no patient was permanent neurological injury reported at hospital discharge. In 4 of these patients, EEG signs of cerebral ischemia were present at both observation times, and in one of them, the duration of cerebral ischemia was less than 2 minutes. The percentage rSo2 reduction from baseline during the carotid clamping test was 17% +/- 4% in patients requiring shunt placement and only 8% +/- 6% in those who did not require it (P = .01). A decrease in rSo2 15% or greater during the carotid clamping test was associated with a 20-fold increase in the odd for developing severe cerebral ischemia (odds ratio, 20; 95% confidence interval, 6.7-59.2) (P = .001); however, this threshold had a 44% sensitivity and 82% specificity, with only 94% negative predictive value. CONCLUSIONS Continuous rSo2 monitoring is a simple and noninvasive method that correlates with the development of clinical and EEG signs of cerebral ischemia during carotid cross-clamping; however, we could not identify an rSo2 threshold that can be used alone to predict the need for shunt placement because of the low sensitivity and specificity.
Collapse
Affiliation(s)
- Andrea Rigamonti
- Department of Anesthesiology, Vita-Salute University of Milan, IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | | | | | | | | | | |
Collapse
|
22
|
Kim JY, Kwak YL, Oh YJ, Kim SH, Yoo KJ, Hong YW. Changes in jugular bulb oxygen saturation during off-pump coronary artery bypass graft surgery. Acta Anaesthesiol Scand 2005; 49:956-61. [PMID: 16045656 DOI: 10.1111/j.1399-6576.2005.00739.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The effect of haemodynamic derangement during coronary artery anastomosis in off-pump coronary artery bypass surgery on cerebral blood flow has not been elucidated. Jugular bulb oxygen saturation is a useful indicator of cerebral blood flow provided that the cerebral metabolic rate is constant. This study was designed to evaluate the changes in jugular bulb oxygen saturation during off-pump coronary artery bypass surgery. METHODS With IRB approval, 48 patients were included. After anaesthesia, an 18-G catheter was introduced into the jugular bulb. Haemodynamic variables and oxygen profiles from gas analysis of jugular bulb blood and arterial blood were obtained: after sternotomy (baseline); at 5 min after the beginning of the anastomosis of the left anterior descending artery, obtuse marginal artery, and right coronary artery; and after sternal closure. RESULTS Cardiac index and mixed venous oxygen saturation decreased significantly during anastomosis of all three arteries compared to the baseline value. Although the changes in jugular bulb oxygen saturation during anastomosis were statistically significant compared to its baseline value, jugular bulb oxygen saturation remained within normal limit throughout the study. CONCLUSIONS Jugular bulb oxygen saturation, which represents the global cerebral oxygenation, was well maintained during the anastomosis of all coronary arteries despite significant haemodynamic changes during off-pump coronary artery bypass (OPCAB).
Collapse
Affiliation(s)
- J Y Kim
- Department of Anesthesiology and Pain Medicine, Gachon Medical School, Gil Medical Center, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
23
|
Brain tissue oxygenation index measured by near infrared spatially resolved spectroscopy agreed with jugular bulb oxygen saturation in normal pediatric brain: a pilot study. Childs Nerv Syst 2005; 21:181-4. [PMID: 15645242 DOI: 10.1007/s00381-004-1079-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2004] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This observational, prospective pediatric human study was performed to determine the agreement between brain tissue oxygenation indices (TOI) measured by near infrared spatially resolved spectroscopy and jugular bulb oxygen saturation values (SjO(2)). METHODS Five cardiac patients without neurological impairment who were admitted into the critical care unit after open-heart surgery with jugular bulb venous catheters were enrolled. Their mean age was 8.6 months and mean body weight was 6.7 kg. Simultaneous measurements of brain TOI using NIR0-300 (Hamamatsu Photonics, Hamamatsu City, Japan) and SjO(2) values from blood samples were recorded. RESULTS The TOI range was 59+/-9% and the SjO(2) range was 58+/-17%. The correlation coefficient R was 0.64 (p=0.11; n=14). Bland-Altman plotting revealed a bias of -3.4%, and precision of 7.2% (n=14). Intra-class correlation reliability analysis showed kappa of 0.55. CONCLUSION Statistically, brain TOI was in reasonable agreement with SjO(2) in pediatric patients with normal brain within the measurement range from 50 to 70%.
Collapse
|
24
|
Cua CL, Hoffman TM, Taeed R, Weinstein S, Gomez D, Olshove VF, Craenen JM. Cerebral saturations trend with mixed venous saturations in patients undergoing extracorporeal life support. Perfusion 2005; 19:171-6. [PMID: 15298425 DOI: 10.1191/0267659104pf738oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cerebral saturation (SCO2) monitors are noninvasive tools that continuously measure saturations in the cerebral cortex, a predominately venous bed. The purpose of this study was to see if a trend existed between measurements of SCO2 and mixed venous saturation values (SVO2) for patients on extracorporeal life support (ECLS). Six patients required ECLS for cardiac failure after congenital cardiac surgery, and one patient required ECLS for pulmonary failure. Patients were divided into two groups, those without systemic/pulmonary venous mixing (n = 3, Group I) and those with mixing due to an intraatrial shunt or left ventricular vent (n = 4, Group II). The age of patients was 0.4 +/- 0.5 years (mean +/- SD), weight was 5.2 +/- 2.3 kg, and time on ECLS was 8.3 +/- 4.8 days. No significant abnormalities were seen on head imaging. A total of 786 paired data points were collected. Mean values were different; however, there was a significant trend between SCO2 and SVO2 for the entire sample (R2 = 0.66, p < 0.001). Cerebral saturation trends follow mixed venous trends and, therefore, may be helpful in combination with other physical and laboratory findings in the care of the critically ill child.
Collapse
Affiliation(s)
- Clifford L Cua
- Division of Cardiology, Department of Pediatrics, Columbus Children's Hospital, The Ohio State University College of Medicine, Columbus, OH 43205-2696, USA
| | | | | | | | | | | | | |
Collapse
|
25
|
Newman DH, Callaway CW, Greenwald IB, Freed J. Cerebral oximetry in out-of-hospital cardiac arrest: standard CPR rarely provides detectable hemoglobin–oxygen saturation to the frontal cortex. Resuscitation 2004; 63:189-94. [PMID: 15531071 DOI: 10.1016/j.resuscitation.2004.05.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Favorable neurological survival in out-of-hospital cardiac arrest (OOHCA) may be influenced by cerebral perfusion during resuscitation. Cerebral oximetry (COx) provides a portable, noninvasive, real-time index of cerebral perfusion that has not been studied in OOHCA. This study examined the feasibility of using COx to measure cerebral perfusion during OOHCA. As a secondary aim, we tested the hypothesis that cerebral perfusion, measured by COx, would decrease with hyperventilation. Subjects were patients with medical OOHCA. A physician responded to the scene of cardiac arrest calls and applied an INVOS 3000 COx probe (Somanetics) to the frontal skull. In a cross-over design, readings were recorded for 2 min while ventilation rate was maintained at 10/min, then for 2 min at 24/min. COx readings were recorded by the oximeter and manually by the investigator. Statistical analyses were done using a paired t-test. Sixteen subjects were enrolled, four had return of pulses. COx reliably detected cortical oxygenation in only one subject during cardiac arrest. None of 16 patients exhibited consistently detectable levels of oxygen during cardiac arrest. In three subjects with ROSC, readings increased with return of pulses and with increasing blood pressure. In a fourth subject the protocol was completed and the device removed, subsequently ROSC was noted and the device re-applied. No patient exhibited any change in oxygen levels with variation of ventilation rates during CPR. The use of cerebral oximetry during OOHCA is feasible. In our sample of OOHCA patients, cerebral perfusion is rarely detectable using an oximeter during CPR. Ventilation rate does not alter the oximeter readings. It is possible that the current standard mechanical method of cardiopulmonary resuscitation provides little or no cerebral oxygenation during OOHCA.
Collapse
Affiliation(s)
- David H Newman
- Department of Emergency Medicine, St. Luke's Roosevelt Hospital, 1111 Amsterdam Avenue, New York, NY 10025, USA.
| | | | | | | |
Collapse
|
26
|
|
27
|
Affiliation(s)
- Tod B Sloan
- Department of Anesthesiology, University of Texas Health Science Center at San Antonio, 78229-7838, USA
| |
Collapse
|