Transcranial cerebral oximetry (TCCO) monitoring in neurosurgical critically ill patients

Introduction

Near-infrared spectroscopy (NIRS) has been used to monitor cerebral oxygenation in various clinical fields. However, its utility has not been demonstrated in more complex situations, such as neurosurgical critically ill patients. The objective of this study was to examine the ability of TCCO to detect cerebrovascular events, such as oligemic hypoxia, relative cerebral hyperemia and vasospasm in neurosurgical critically ill patients with different outcome.

Methods

This study involved a retrospective analysis of regional cerebral saturation(rSO₂) data collected in 64 neurosurgical patients in critical states using the INVOS 4100 cerebral oximeter as a part of multimodal neuromonitoring. Patients were divided into three groups: group I, good outcome/moderate disability (GOS 5–4, 14 male/four female, 38.9 years old); group II, severe disability/vegetative state (GOS 3–2, 12 male/four female, 37.6 years old); and group III, dead (20 male/10 female, 39.2 years old). The outcome was assessed at discharge of the patients from the hospital.

Results

TCCO monitoring detected a pathological pattern of regional cerebral oxygenation in 83% of patients. In patients with vasospasm, early appearance and increasing rSO₂ fluctuations more than 10% were correlated with poor outcome. 74.3% of patients where we monitored both rSO₂ and SjbO₂ have had the same pattern of increased or decreased parameters (Table 1).

Table 1

Discussion

As a noninvasive, bedside, nonoperator-dependent tool TCCO is effective in identifying such cerebrovascular events as oligemic cerebral hypoxia, relative cerebral hyperemia and vasospasm, which were more pronounced in neurosurgical patients with unfavorable outcome.