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Cerebral Oximetry Monitoring Clinical Protocol - Casecag.com

Cerebral Oximetry Monitoring Clinical Protocol - Casecag.com

Cerebral Oximetry Monitoring Clinical Protocol - Casecag.com

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†<strong>Clinical</strong> protocols are based on the best and most recent available data and therefore are expected to befollowed by all CASECAG staff unless there is a <strong>com</strong>pelling clinical reason not to (which should bedocumented in the anesthesia record), or new data be<strong>com</strong>es available that suggests an alternate treatmentprotocol. Standardizing the approach to some of our practices is expected to have a positive impact in theclinical environment and improve ease of work flow for the trainees.‡<strong>Cerebral</strong> oximetry use in cardiac surgery has repeatedly demonstrated an improvement in clinical out<strong>com</strong>eswhen studied with prospective, randomized controlled trial and retrospective methodologies (Murkin et al.,Slater et al., Goldman et al.). CASECAG staff and clinicians are expected to employ this technology for eachpatient unless there is an outstanding contraindication to its use (e.g., massive forehead cutaneous trauma).1: This protocol is intended for use in patients undergoing all varieties of cardiac surgical procedures either withor without the use of cardiopulmonary bypass (CPB). While cerebral oximetry has been shown to improveclinical out<strong>com</strong>es in vascular surgical (Botes et al.) and elderly general surgical patients (Casati et al.) thisprotocol is designed to be used specifically on cardiac surgical patients.2: Placement of the sensor pads over hair can result in the phenomenon of “light piping.” Light piping involveshair acting as a fiber optic cable and transmitting ambient near infrared (NIR) light photons into thephotoreceptor and thus disturbing the accuracy of the rSO 2 signal. (Avery EG). Placing the pads too high on theforehead may result in an inaccurate signal if the sensors are located over the cavernous sinus as the pooledvenous blood in this vascular structure will act as a chromophore sink and absorb all of the NIR light emittedphotons, thus preventing the generation of useful rSO 2 data.3: Under most clinical conditions cerebral oximeters will produce a clinical useful rSO 2 value. Pulsatileperfusion is not necessary for the device to produce a useful value. Ambient light contamination is among themost <strong>com</strong>mon reasons that the device will not produce a readable value. (Avery EG) Other reasons that thisdevice will not generate a value include very darkly pigmented skin (e.g., African-American patients), otherunappreciated chromophores in the cutaneous tissue (e.g., collagen) and placing the sensors over darklypigmented hair.4: For a patient that cannot tolerate room air ventilation in the awake state consider obtaining the room airbaseline once the patient is intubated by transiently lowering the FiO 2 to 0.21. Alternatively, in clinicalsituations where a room air baseline cannot be obtained even in an intubated state set your baseline at someFiO 2 consistent with clinical stability.5: Recently published data by Heringlake et al. strongly suggest that cardiac surgical patients with oxygensupplemented room air baseline rSO 2 values ≤ 50% have a significantly higher incidence of postoperativemorbidity and mortality.

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