Cerebral Oxygenation Monitoring

A Strategy to Detect Intraventricular Hemorrhage and Periventricular Leukomalacia

Heather E. Elser, MSN, RN, NNP-BC, CNS, PhD Student; Diane Holditch-Davis, PhD, RN, FAAN; Debra H. Brandon, PhD, RN, CCNS, FAAN

Disclosures

NAINR. 2011;11(3):153-159. 

In This Article

Advantages and Disadvantages of Cerebral Oxygenation Monitoring

The advantages of using a cerebral oximeter include providing noninvasive, real-time data to the clinician at the bedside for immediate care decisions and immediate observations of the effects of interventions (see Table 2). Cerebral oxygenation monitoring provides continuous information with little to no hindrance of nursing or medical care.[54,55] Care decisions not only have the potential to improve patient outcomes by reducing neurologic complications but also decrease hospital costs by up to 400%.[56]

Disadvantages also exist for cerebral oxygenation monitoring. First of all, cerebral oxygenation values do not provide information on how much oxygen reaches the brain nor can it be inferred how the brain metabolizes oxygen.[57] Some studies have established equations to determine cerebral metabolism of oxygen by fractional tissue oxygenation exchange, but these values are not provided as part of the commercial cerebral oximeter output.[58,59] Therefore, changes seen in cerebral oxygenation values could be misleading, as it may not directly relate to physiologic processes occurring in the brain but instead to blood flow before or immediately after the brain, as in cerebral venous congestion.

Another disadvantage relates to the cerebral oxygenation probe placement. Regardless of how many cerebral oximeter probes are used, a large amount of brain tissue will remain unmonitored, and only the brain tissue underlying each probe will be examined for the presence of oxygenation (see Table 2). This is important to keep in mind because to capture in real time the unfolding of IVH or PVL, the cerebral oximeter probe may have to be strategically placed, especially with PVL, since it effects multiple sites in the brain. Currently, the best landmark(s) for the cerebral oximeter probe to monitor neurologic complications has not been identified.

In addition to location, how to attach the probe is also of concern, knowing that skin integrity is an issue when caring for premature infants. Careful consideration must be taken to protect the skin when attaching a cerebral oximeter probe to the head. Nonadhesive probes secured by headbands seem to be the least irritating to the skin, but using hydrogel tape or Tegaderm (3M Health Care, St Paul, Minnesota) is also a possibility, depending on the age of the infant. Manufacturer's suggest using a new probe every 24 hours and following unit policies for skin assessment.[60]

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