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Minerva Anestesiologica 2021 May 03

DOI: 10.23736/S0375-9393.21.15333-7


lingua: Inglese

The role of non-invasive brain oximetry in adult critically ill patients without primary brain injury

Rafael BADENES 1, 2, 3 , Elisa G. BOGOSSIAN 4, Vicente CHISBERT 3, 5, Chiara ROBBA 6, Mauro ODDO 7, Fabio S. TACCONE 4, Basil F. MATTA 8

1 Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de Valencia, University of Valencia, Valencia, Spain; 2 Department of Surgery, School of Medicine, University of Valencia, Valencia, Spain; 3 INCLIVA Health Research Institute, Valencia, Spain; 4 Department of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; 5 Escuela de Doctorado, Universidad Católica de Valencia, Valencia, Spain; 6 Anaesthesia and Intensive Care, IRCSS S. Martino Hospital, Genoa, Italy; 7 Department of Intensive Care Medicine, Faculty of Biology and Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital, Lausanne, Switzerland; 8 Trauma and NeuroCritical Care Unit, Cambridge University Hospital, Cambridge, UK


A primary objective in intensive care and perioperative settings is to promote an adequate supply and delivery of oxygen to tissues and organs, particularly to the brain. Cerebral near infrared spectroscopy (NIRS) is a non-invasive, continuous monitoring technique, that can be used to assess cerebral oxygenation. Using NIRS to monitor cerebral oximetry is not new, and has been in widespread use in neonates and cardiac surgery for decades. In addition, it has become common to see NIRS being used in adult and pediatric cardiac surgery, acute neurological diseases, neurosurgical procedures, vascular surgery, severe trauma and other acute medical diseases. Furthermore, recent evidence suggests a role for NIRS in the perioperative settings; detecting and preventing episodes of cerebral desaturation aiming to reduce the development of post-operative delirium. NIRS is not without its limitations; these include the risk of extra-cranial contamination, spatial limitations and skin blood flow/volume changes, as well being a measure of localized blood oxygenation underneath the sensor. However, NIRS is a non-invasive technique and can, therefore, be used in those patients without indications or justification for invasive brain monitoring; non-neurosurgical procedures such as liver transplantation, major orthopedic surgery and critically illness where the brain is at risk. The aim of this manuscript was to discuss the physical principles of NIRS and to report the current evidence regarding its use in critically ill patients without primary non-anoxic brain injury.

KEY WORDS: Cerebral oxygenation; Monitoring; Intensive care unit; Delirium; Postoperative complications

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