The Value of Cerebral Oximetry Monitoring in Cardiac Surgery: Challenges and Solutions in Adult and Pediatric Practice.

CEREBRAL OXIMETRY with near infrared spectroscopy has gained traction in contemporary practice as a monitor of brain perfusion during cardiac surgery. 1 Slater JP Guarino T Stack J et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg. 2009; 87: 36-44 Abstract Full Text Full Text PDF PubMed Scopus (469) Google Scholar , 2 Deschamps A Hall R Grocott H et al. Cerebral oximetry monitoring to maintain normal cerebral oxygen saturation during high-risk cardiac surgery: A randomized controlled feasibility trial. Anesthesiology. 2016; 124: 826-836 Crossref PubMed Scopus (151) Google Scholar Recent clinical trials have suggested that cerebral desaturation may herald neurocognitive dysfunction after cardiac surgery and that directing therapy to treat these desaturation events often is effective. 1 Slater JP Guarino T Stack J et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg. 2009; 87: 36-44 Abstract Full Text Full Text PDF PubMed Scopus (469) Google Scholar , 2 Deschamps A Hall R Grocott H et al. Cerebral oximetry monitoring to maintain normal cerebral oxygen saturation during high-risk cardiac surgery: A randomized controlled feasibility trial. Anesthesiology. 2016; 124: 826-836 Crossref PubMed Scopus (151) Google Scholar Despite these observations, high-quality prospective trials demonstrating improved clinical outcomes after cardiac surgery owing to this monitoring are lacking. A recent meta-analysis of 10 randomized controlled trials failed to show any outcome benefit after cardiac surgery owing to monitoring and management of cerebral oximetry. 3 Serraino GF Murphy GJ Effects of cerebral near-infrared spectroscopy on the outcome of patients undergoing cardiac surgery: A systematic review of randomized trials. BMJ Open. 2017; 7: 1-13 Crossref Scopus (72) Google Scholar In this case conference, 3 cases are presented during which acute declines in cerebral saturation monitoring (INVOS; Medtronic, Minneapolis, MN) alerted the heart team to consider mechanical vascular obstruction during cardiac surgery. In each case, prompt recognition and management allowed for restoration of cerebral saturation to baseline levels. After the case reports are described, 2 expert commentaries explore the applications of this monitoring modality in both adult and pediatric perioperative practice.