Cerebral oximetry

[Wiscoblue]

Are any of you guys using cerebral oximetry for cardiovascular cases? Are there any benefits?


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[Shimmy8]

We do because perfusion team insists on it.

None of my cardiac attendings pay much attention though we do trend it for every cardiac case.

 

[OB1🤙]

In residency and fellowship we used it routinely.

I hardly use it anymore outside of circ arrest cases. Not never, but pretty infrequently. If I have time later I'll write a post why, but Cliff's Notes version is that it almost never changes what I do, or tells me something I don't already know. And the stickers aren't cheap.

I will say this as well: the Invos system is garbage. If you're going to use anything, the Foresight and Equinox are both far superior to the Invos.

 

[Mman]

vascular? No. I do use it periodically in sitting position cases in old decrepit type patients.

 

[Wiscoblue]

So when you do apply it to the patient, what are you looking for, and what do you do to make things 'normal'? Is there any evidence that using it helps to improve outcome, prevent strokes or reduce morbidity in any way?

We were asked by our perfusion group to consider using cerebral oximetry. I'm just interested in knowing if anyone out there uses it and what the benefits are.


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[Mman]

So when you do apply it to the patient, what are you looking for, and what do you do to make things 'normal'?

Put it on in preop holding to get a room air unsedated baseline reading. Intraop keep it at least within 20%. If it's low, increase the delivery of oxygen to the brain.

 

[Random Anesthesiologist]

We use foresight with neuro cases too

 

[nimbus]

He's a paid speaker for covidien but here you go.

http://casecag.com/education/Clin Util Monit CerOx_FINAL.pdf

 

[OB1🤙]

So, I've seen massive strokes in people who had pristine cerebral sats all case.

I've seen people do just fine after very very concerning intraop cerebral sats.

So I think the sensitivity and specificity of this not-cheap monitor is unacceptably poor *for the indication people associate it with,* which is detection of a focal stroke.

Yes, the cerebral sats will drop in the setting of global hypoperfusion. You shouldn't need a cerebral sat monitor to know you're globally hypoperfusing.

The only thing the evidence really says is that if you have a misdirected cannula or something, this can pick it up. I submit that you should know if your cannula is misdirected in other ways.

The indication for beach chair positioning in a marginal patient is fine I think.

I think at the end of the day, perfusionists, much like ICU nurses, want numbers to reassure them. But since good numbers don't mean everything is good in the whole brain, and bad numbers don't mean the patient will wake up stroked out, I don't use these monitors routinely.

 

[Consigliere]

I use it as much as I use the BIS and as much as I take advice from CRNAs: never.

 

[caligas]

I use it as much as I use the BIS and as much as I take advice from CRNAs: never.

You forgot nexfin/flotrac

 

[epidural man]

So, I've seen massive strokes in people who had pristine cerebral sats all case.

I've seen people do just fine after very very concerning intraop cerebral sats.

So I think the sensitivity and specificity of this not-cheap monitor is unacceptably poor *for the indication people associate it with,* which is detection of a focal stroke.

Yes, the cerebral sats will drop in the setting of global hypoperfusion. You shouldn't need a cerebral sat monitor to know you're globally hypoperfusing.

The only thing the evidence really says is that if you have a misdirected cannula or something, this can pick it up. I submit that you should know if your cannula is misdirected in other ways.

The indication for beach chair positioning in a marginal patient is fine I think.

I think at the end of the day, perfusionists, much like ICU nurses, want numbers to reassure them. But since good numbers don't mean everything is good in the whole brain, and bad numbers don't mean the patient will wake up stroked out, I don't use these monitors routinely.

You've seen a massive stroke with normal Cerebral Oximeter numbers? Wow. I would right that up. That is kinda strange.

As a resident I was aPI on a study where we made healthy volunteers hypoxic and measure pulmonary artery pressures via TTE. We measured BIS and Cerebral Oximeters on each volunteer. FiO2 was titrated to maintain sats to 70%. When I did it, I got down to 65% and then tried to hold my breath - and my attending PI got mad and made me breath - but anyway, the Cerebral Oximeter numbers were pretty consistently parralel to the SpO2. The BIS didn't change really in anyone.

 

[boujieboujie]

I use it mostly as a surrogate for mixed venous in the heart room. During times when I'm mentally masturbating of whether or not to give blood products, the cer ox can help me come to a decision.

 

[OB1🤙]

You've seen a massive stroke with normal Cerebral Oximeter numbers? Wow. I would right that up. That is kinda strange.

A thrombotic MCA or PCA stroke won't have any effect on a frontal brain sat.