Monitoring with the Somanetics INVOS 5100C after aneurysmal subarachnoid hemorrhage.
BACKGROUND
Vasospasm is a major cause of morbidity after subarachnoid hemorrhage (SAH), and current screening techniques (angiography, transcranial Doppler [TCD], and clinical examination) have serious limitations. Brain oximetry is a promising noninvasive tool to detect reduced brain oxygenation from vasospasm.


METHODS
Consecutive SAH patients at high risk for vasospasm were monitored with the INVOS (Somanetics, IL, USA) 5100C cerebral oximeter. We prospectively collected oximeter readings (rO2) with concurrent values for vital signs, intracerebral pressure (ICP), arterial blood gas measurement, and hemoglobin (HGB). Data were prospectively collected every 12 h and at clinical events (angiography, transfusion, etc.). We prospectively recorded clinical history, clinical events, radiology results, and outcomes.


RESULTS
Six patients were measured 123 times. rO2 values were correlated with the contralateral side, HGB, blood pressure, and PaO2, but not with ICP or perfusion pressure. There were no measured effects of angiography or transfusion. Patterns relating rO2 readings to clinical, angiographic, or TCD evidence of vasospasm were unclear, and there were no associations with the outcome (cerebral infarction, NIH Stroke Scale, or modified Rankin Scale).


CONCLUSIONS
INVOS rO2 readings are associated with other factors that relate to cerebral oxygen delivery but seem to be of limited use as a screening tool for vasospasm or cerebral infarction after SAH.
Naidech
Andrew M
AM
Northwestern University, Chicago, IL, USA. a-naidech@northwestern.edu
Bendok
Bernard R
BR
Ault
Michael L
ML
Bleck
Thomas P
TP
D000328:Adult; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D001921:Brain / Q000378:metabolism; D002544:Cerebral Infarction / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010092:Oximetry / Q000295:instrumentation*; D010108:Oxyhemoglobins / Q000378:metabolism; D019095:Point-of-Care Systems; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000378:metabolism* / Q000628:therapy; D020301:Vasospasm, Intracranial / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism
D010108:Oxyhemoglobins