Journal of Clinical Monitoring and Computing 2017/2018 end of year summary: monitoring—and provocation—of the microcirculation and tissue oxygenation

Vos, Jaap Jan; Ellermann, Sophie; Scheeren, Thomas

doi:10.1007/s10877-019-00270-7

Cited by 14 publications

(12 citation statements)

References 36 publications

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“…The limitation of our study is the lack of analysis of the postoperative period as one or another monitoring device implementation in clinical practice should also improve postoperative period or organ-related outcome [13]. The majority of studies show clear benefit of rScO 2 intraoperative monitoring.…”

Section: Discussionmentioning

confidence: 93%

Regional Cerebral Oxygen Saturation Monitoring during Spinal Surgery in Order to Identify Patients at Risk for Cerebral Desaturation

et al. 2020

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Featured Application: The aim of our study was to evaluate the usefulness of intraoperative cerebral oxygenation monitoring during spinal surgery. Study includes specifically spinal neurosurgical patients, as spinal surgery, being performed in prone position, carries a certain risk for altered cerebral blood perfusion and oxygen supply. As a result, we show a benefit of cerebral oxygen saturation non-invasive intraoperative monitoring using Near infrared spectroscopy devices cerebral oximeters as in couple of patients we saw cerebral oxygen saturation drop below threshold values that would otherwise stay unrecognized as other intraoperative measurements stayed stable during cerebral oxygen desaturation. Abstract: Background: Near infrared spectroscopy (NIRS) devices are non-invasive and monitor cerebral oxygen saturation (rScO 2 ) continuously. NIRS interventional protocol is available in order to avoid hypoxic brain injury. Methods: We recruited patients scheduled for spinal surgery (n = 44). rScO 2 was monitored throughout the surgery using INVOS 4100 cerebral oximeter. If the rScO 2 values dropped more than 20% below baseline, or there was an absolute drop to below 50%, NIRS interventional protocol was followed. Results: In two patients rScO 2 decreased by more than 20% from baseline values. In one patient rScO 2 decreased to below 50%. NIRS protocol was initiated. As the first step, correct head position was verified-in one patient rScO 2 increased above the threshold value. In the two remaining patients, mean arterial pressure was raised by injecting Ephedrin boluses as the next step. rScO 2 raised above threshold. Patients with desaturation episodes had longer medium time of the operation (114 ± 35 versus 200 ± 98 min, p = 0.01). Pearson's correlation showed a negative correlation between rScO 2 and duration of operation (r = −0.9, p = 0.2). Receiver operating characteristic curve analysis showed blood loss to be a strong predictor for possible cerebral desaturation (Area under the curve (AUC): 0.947, 95%CI: 0.836-1.000, p = 0.04). Conclusion: Patients with higher blood loss might experience cerebral desaturation more often than spinal surgery patients without significant blood loss.

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Section: Discussionmentioning

confidence: 93%

Regional Cerebral Oxygen Saturation Monitoring during Spinal Surgery in Order to Identify Patients at Risk for Cerebral Desaturation

et al. 2020

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“…Continuous monitoring of ScvO 2 would represent a major advance for clinicians to detect physiological changes in the oxygen consumption of underlying tissue which will enable us to estimate life-threatening events earlier. Also, using a noninvasive continuous technique for monitoring ScvO 2 , will decrease iatrogenic complications such as infection, embolization, and iatrogenic anemia with a decreased number of blood samples taken from the pediatric patients which are very crucial especially for low weight pediatric patients [6][7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Noninvasive monitoring of central venous oxygen saturation by jugular transcutaneous near-infrared spectroscopy in pediatric patients undergoing congenital cardiac surgery

Altun¹,

Doğan²,

Arnaz³

et al. 2020

Turk J Med Sci

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Background and aim: In patients undergoing congenital cardiac surgery, it is crucial to maintain oxygen demand-consumption balance. Central venous oxygen saturation (ScvO 2) is a useful indicator of oxygen demand and consumption balance which is an invasive method. Near-infrared spectroscopy (NIRS) is a noninvasive, continuous monitoring technique that measures regional tissue oxygenation. NIRS that is placed over the internal jugular vein cutaneous area (NIRSijv) has the potential to show ScvO 2 indirectly. In this study, we aimed to determine the correlation between ScvO 2 with NIRSijv in pediatric patients undergoing congenital cardiac surgery. Materials and methods: Fifty children participated in the study. Four patients were excluded for the inability of internal jugular vein (IJV) catheterization due to technical difficulties. After anesthesia induction, NIRS probes were placed on the IJV site with ultrasound guidance for the measurement of continuous transcutaneous oxygen saturation. The catheter insertion was also done through the IJV from the other side using ultrasound guidance. Cerebral oxygenation monitoring was done using NIRS with a single pediatric probe placed on the right forehead. Values of NIRSijv, cerebral NIRS (NIRSc) and ScvO 2 , were recorded at certain times until postoperative 24th hour. Results: Data were collected at 8 different time points. There was a significant correlation between ScvO 2 and NIRSijv in all measurement time points (r = 0.91), (P = 0.001). The mean bias between ScvO 2 and NIRSijv was 2.92% and the limits of agreement were from 11% to-5.2%. There was a moderate correlation between ScvO 2 and NIRSc (r = 0.45), (P = 0.001). The mean bias between ScvO 2 and NIRSc was 2.7% and the limits of agreement were from +26% to-20%. Conclusion: In this study, we found a strong correlation between ScvO 2 and NIRS measurements taken from the internal jugular vein site. Accordingly, continuous noninvasive monitoring with transcutaneous NIRSijv can be an alternative method as a trend monitor for the central venous oxygen saturation in pediatric cardiac patients undergoing congenital cardiac surgery.

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“…Conventional methods of monitoring the progress of septic patients include so-called "upstream" variables reflecting oxygen delivery (cardiac output, mean arterial pressure) and "downstream" variables reflecting oxygen utilization (mixed venous oxygen saturation, 301 lactate levels, urine output). Because these measures may not reflect microcirculatory derangement, methods of clinically evaluating the microcirculation have been developed [302][303][304][305][306] (eg, sublingual capnometry, sidestream dark-field video microscopy, orthogonal polar spectral imaging [307][308][309][310][311][312][313] ). While imaging methods are not in widespread clinical use, algorithms to analyze such images 314,315 can provide serial measurements of local flow velocities, the percentage of perfused vessels, and effective vessel density.…”

Section: Monitoringmentioning

confidence: 99%

Effects of impaired microvascular flow regulation on metabolism‐perfusion matching and organ function

Roy

Secomb

2020

Microcirculation

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In caring for the critically ill, clinicians may face the conundrum of a patient with normal ventilation, cardiac output, and arterial oxygen saturation, but with evidence of renal 1 or hepatic 2 failure.Conventional clinical decision-making in these situations is often based on macroscopic parameters such as heart rate and blood pressure that do not provide insight into conditions at the microvascular level. As a result, therapeutic decisions may not address the underlying pathophysiological derangements leading to organ failure.Normal tissue function depends on adequate oxygen supply.Although cellular hypoxia can result from defects anywhere along the oxygen transport pathway (pulmonary uptake, blood flow, uptake by mitochondria), deficits not attributable to impairment of overall ventilation or blood flow can result from heterogeneous oxygen transport at the microvascular level. Tissue oxygen levels vary widely over short length scales (tens of microns). Microvascular networks are heterogeneous in structure (diameter, length of flow pathways) and function (flow velocity, oxygen content). This heterogeneity can result in impaired oxygen extraction, 3 and regions of hypoxia or anoxia can occur even in tissue that receives an adequate overall oxygen supply. 4,5 This review addresses the role of local regulation of blood flow in overcoming this heterogeneity and matching perfusion to metabolic demand under normal and pathological conditions.

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Journal of Clinical Monitoring and Computing 2017/2018 end of year summary: monitoring—and provocation—of the microcirculation and tissue oxygenation

Cited by 14 publications

References 36 publications

Regional Cerebral Oxygen Saturation Monitoring during Spinal Surgery in Order to Identify Patients at Risk for Cerebral Desaturation

Regional Cerebral Oxygen Saturation Monitoring during Spinal Surgery in Order to Identify Patients at Risk for Cerebral Desaturation

Noninvasive monitoring of central venous oxygen saturation by jugular transcutaneous near-infrared spectroscopy in pediatric patients undergoing congenital cardiac surgery

Effects of impaired microvascular flow regulation on metabolism‐perfusion matching and organ function

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