Continuous Measurement of Cerebral Oxygenation with Near-Infrared Spectroscopy after Spontaneous Subarachnoid Hemorrhage

Objective. The aim of our prospective study was to investigate the applicability and the diagnostic value of near-infrared spectroscopy (NIRS) in SAH patients using the cerebral oximeter INVOS 5100C. Methods. Measurement of cerebral oximetry was done continuously after spontaneous SAH. Decrease of regional oxygen saturation (rSO2) was analyzed and interpreted in view of the determined intrinsic and extrinsic factors. Changes of rSO2 values were matched with the values of ICP, tipO2, and TCD and the results of additional neuroimaging. Results. Continuous measurement of rSO2 was performed in nine patients with SAH (7 females and 2 males). Mean measurement time was 8.6 days (range 2–12 days). The clinical course was uneventful in 7 patients without occurrence of CVS. In these patients, NIRS measured constant and stable rSO2 values without relevant alterations. Special findings are demonstrated in 3 cases. Conclusion. Measurement of rSO2 with NIRS is a safe, easy to use, noninvasive additional measurement tool for cerebral oxygenation, which is used routinely during vascular and cardiac surgical procedures. NIRS is applicable over a long time period after SAH, especially in alert patients without invasive probes. Our observations were promising, whereby larger studies are needed to answer the open questions.

[1]  W. Thies,et al.  Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. , 1994, Stroke.

[2]  C. Lazaridis,et al.  Risk factors and medical management of vasospasm after subarachnoid hemorrhage. , 2010, Neurosurgery clinics of North America.

[3]  D. Moehle.  Neuromonitoring in the cardiopulmonary bypass surgical patient: clinical applications. , 2001, The journal of extra-corporeal technology.

[4]  M Hiesmayr,et al.  Cerebral oxygenation during cardiopulmonary bypass measured by near-infrared spectroscopy: effects of hemodilution, temperature, and flow. , 1999, Journal of cardiothoracic and vascular anesthesia.

[5]  K. Roberts,et al.  NEAR INFRARED SPECTROSCOPY DETECTS CRITICAL CEREBRAL HYPOXIA DURING CAROTID ENDARTERECTOMY IN AWAKE PATIENTS , 1998 .

[6]  N. Kitchen,et al.  Triple-H therapy in the management of aneurysmal subarachnoid haemorrhage , 2003, The Lancet Neurology.

[7]  Aman B Patel,et al.  Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association , 1994, Stroke.

[8]  E. Keller,et al.  Novel treatments for vasospasm after subarachnoid hemorrhage , 2012, Current opinion in critical care.

[9]  Marek Czosnyka,et al.  Continuous Assessment of Cerebral Autoregulation With Near-Infrared Spectroscopy in Adults After Subarachnoid Hemorrhage , 2010, Stroke.

[10]  J. Ohman,et al.  Extracranial contribution to cerebral oximetry in brain dead patients: a report of six cases. , 1999, Journal of neurosurgical anesthesiology.

[11]  K. Slavin,et al.  Use of transcranial cerebral oximetry to monitor regional cerebral oxygen saturation during neuroendovascular procedures. , 1995, AJNR. American journal of neuroradiology.

[12]  E. Macdonald,et al.  Aneurysmal Subarachnoid Hemorrhage , 1989, The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses.

[13]  P. Horn,et al.  Quantitative Regional Cerebral Blood Flow Measurement Techniques Improve Noninvasive Detection of Cerebrovascular Vasospasm after Aneurysmal Subarachnoid Hemorrhage , 2001, Cerebrovascular Diseases.

[14]  G. Litscher,et al.  An NIRS matrix for detecting and correcting cerebral oxygen desaturation events during surgery and neuroendovascular procedures , 2005, Neurological research.

[15]  A. Cruickshank,et al.  Subarachnoid haemorrhage , 2007, The Lancet.

[16]  K. Welch,et al.  Evaluation of a Cerebral Oximeter as a Monitor of Cerebral Ischemia during Carotid Endarterectomy , 2000, Anesthesiology.

[17]  L. Dibbelt,et al.  Preoperative Cerebral Oxygen Saturation and Clinical Outcomes in Cardiac Surgery , 2011, Anesthesiology.

[18]  W. Marsden.  I and J , 2012 .

[19]  Jan Claassen,et al.  TRANSCRANIAL DOPPLER FOR PREDICTING DELAYED CEREBRAL ISCHEMIA AFTER SUBARACHNOID HEMORRHAGE , 2009, Neurosurgery.

[20]  Ngianga-Bakwin Kandala,et al.  The Application of Near-infrared Oximetry to Cerebral Monitoring During Aneurysm Embolization: A Comparison With Intraprocedural Angiography , 2007, Journal of neurosurgical anesthesiology.

[21]  Stefan Moritz,et al.  Accuracy of Cerebral Monitoring in Detecting Cerebral Ischemia during Carotid Endarterectomy: A Comparison of Transcranial Doppler Sonography, Near-infrared Spectroscopy, Stump Pressure, and Somatosensory Evoked Potentials , 2007, Anesthesiology.

[22]  R. Ohye,et al.  Near-infrared spectroscopy: what we know and what we need to know--a systematic review of the congenital heart disease literature. , 2009, The Journal of thoracic and cardiovascular surgery.

[23]  P. Horn,et al.  Regional cerebral blood flow monitoring in the diagnosis of delayed ischemia following aneurysmal subarachnoid hemorrhage. , 2003, Journal of neurosurgery.

[24]  M. Weyand,et al.  Noninvasive Control of Adequate Cerebral Oxygenation During Low‐Flow Antegrade Selective Cerebral Perfusion on Adults and Infants in the Aortic Arch Surgery , 2008, Journal of cardiac surgery.

[25]  Masahiko Kawaguchi,et al.  Effects of Hemoglobin Concentration, Skull Thickness, and the Area of the Cerebrospinal Fluid Layer on Near-infrared Spectroscopy Measurements , 2007, Anesthesiology.

[26]  Motoki Oda,et al.  Bedside assessment of cerebral vasospasms after subarachnoid hemorrhage by near infrared time-resolved spectroscopy. , 2010, Advances in experimental medicine and biology.

[27]  J Meixensberger,et al.  Clinical experience with 118 brain tissue oxygen partial pressure catheter probes. , 1998, Neurosurgery.

[28]  N. Yasui,et al.  Continuous Cardiac Output and Near-Infrared Spectroscopy Monitoring to Assist in Management of Symptomatic Cerebral Vasospasm After Subarachnoid Hemorrhage , 2010, Neurocritical care.

[29]  R. Tamargo,et al.  Inflammation and cerebral vasospasm after subarachnoid hemorrhage. , 2010, Neurosurgery clinics of North America.

[30]  G. G. Stokes.  "J." , 1890, The New Yale Book of Quotations.

[31]  P. Nyquist,et al.  Biomarkers and vasospasm after aneurysmal subarachnoid hemorrhage. , 2010, Neurosurgery clinics of North America.

[32]  D. Bainbridge,et al.  Monitoring Brain Oxygen Saturation During Coronary Bypass Surgery: A Randomized, Prospective Study , 2007, Anesthesia and analgesia.