Cerebral oximetry monitoring. To guide physiology, avert catastrophe or both?

Editor, The recent prospective observational study by de la Matta and Dominguez 1 that studied the correlation of laterally (i.e. conventionally) placed dual cerebral oximetry sensors compared with a single midline sensor raises some interesting issues as to how to use this near-infrared spectrographic (NIRS) monitor of cerebral oxygenation. The main focus of their study was to find out whether cerebral saturation measurements obtained from a single sensor would correlate with measurements from each of the bilaterally placed sensors with the rationale being that a single sensor configuration could conceivably be useful for cases in which there is not enough space on the patient's forehead to allow both cerebral oximetry and electroencephalogram monitoring. A single sensor configuration might also have cost reduction considerations. Although they showed reasonable agreement between these sensor configurations, they do specifically mention that this single unifying sensor might not be applicable in certain situations, including those where there is a ‘real or potential’ 1 risk of cerebral malperfusion, such as in aortic arch surgery. Although I completely agree with these authors that this specific indication would be a poor situation to use a single sensor, this does raise the overall issue of how cerebral oximetry monitoring is generally used. That is, is it used to determine the adequacy of global cerebral perfusion (e.g. in a perceived ‘high risk’ patient), or is it used as a safety feature to avert potential catastrophe, in both normal and high risk groups, by detecting unexpected perfusion abnormalities, such as iatrogenic aortic dissection (leading to hemispheric oxygen saturation asymmetry)? 2 Indeed, the malperfusion resulting from this type of injury might not necessarily be picked up by a single midline probe. So if one is suggesting that using a single sensor might be warranted in regular patient management, this likely indicates a NIRS strategy aimed at guiding overall physiology in those considered at high risk, as opposed to it being used more generally to detect catastrophic, albeit rare, events that could conceivably occur in any patient, high or low risk. Their study indirectly speaks to the question as to whether we should monitor all patients with NIRS, or whether we should simply monitor those patients considered at ‘high risk’. Acknowledgements relating to this article Assistance with the letter: none. Financial support and sponsorship: none. Conflicts of interest: none.

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