INVOS® System Case Graphs - Infant/Neonatal
These INVOS® System graphs from real patient cases are a compelling way to see the true impact and value of cerebral/somatic monitoring. Each INVOS® System case graph reveals the patient's regional oxygen saturation (rSO2) values at each stage of surgery or critical care treatment, and its responses to events and interventions.
The following case graphs demonstrate how the INVOS® System can make a positive addition to patient care. Its objective, real-time and site-specific oxygenation data helps care teams react to oxygen imbalances, potentially reducing complications, including some potentially catastrophic in scale.
Effects of Organ Compression and Manipulation
This case study shows cerebral and somatic INVOS® System monitoring during the surgical repair of a giant omphalocele on an infant. Somatic oxygen monitoring enabled clinicians to visualize trends in peri-renal perfusion in real time and prompted changes in their surgical approach in order to provide immediate relief of the abdominal compression. Interventions to resolve the rSO2 desaturations included repositioning the omphalocele, spacing their manipulations to allow for tissue perfusion recovery in between surgical course, ventilator changes, and transfusion of packed red blood cells to replace losses from surgical bleeding. Manipulation of the liver, while the surgeons sutured on the abdominal patch to cover the omphalocele, resulted in peri-renal desaturations with compression over the renal blood supply.
Without the placement of the peri-renal SomaSensor®, prolonged desaturations of this somatic area may have continued, resulting in tissue ischemia, which may have increased the risk of post operative dysfunction.
rSO2 Response during Abdominal Bleed
This observational case study describes a three-week old infant with a history of nephrocalcinosis (calcifications of the kidney) who had undergone abdominal surgery for necrotizing enterocolitis (NEC). On post-op day three, INVOS® System monitoring for cerebral and somatic oximetry was initiated. Baseline trends were lower than expected and the peri-renal rSO2 values, possibly due to the patient's history, continued to decline as the day progressed. Since the caretakers were new to Somanetics' technology and the vital signs were stable and arterial blood gases within normal limits, the only orders given in this regard were to watch and observe for any signs and symptoms of discomfort and changes. On post-op day three, peri-renal rSO2 values continued to trend downward, plummeting to 15 - the lowest reading point of the monitor. Fifteen minutes later, a major abdominal bleed began. There were no other indications or symptoms that this massive abdominal bleed was pending except for the ongoing decline of peri-renal rSO2 values dropping hours earlier. Transfusion of blood products began and rSO2 values immediately began improving. This case study shows how the noninvasive INVOS® System provides information on site-specific tissue perfusion that may provide a warning of hemodynamic compromise.
Alterations in Ventilation Support in RDS
This case study of a 28-week gestation infant with severe Respiratory Distress Syndrome (RDS) shows somatic rSO2 values starting and remaining low yet arterial blood pressure is within normal limits. The infant was supported on high frequency oscillating ventilation. On day two, a large PDA was confirmed by echocardiography (ECHO) and indomethacin treatment was initiated. On day three, a chest x-ray revealed Pulmonary Interstitial Edema (PIE), a condition characterized by hyperexpansion of the lung fields, which can lead to tamponade and decreased cardiac output. Ventilator management was changed from high frequency oscillating ventilation to a high-frequency jet ventilation and inotropes were begun. Over time, this combination greatly improved peri-renal saturations; urine output increased and the PDA was eventually closed. Cerebral and somatic oximetry provided a valuable adjunct to this infant's treatment during assessment of the mechanical ventilation and drug therapy.
rSO2 Decline Associated with Pleural Effusion
Following Atrial Septal Defect (ASD)/Ventricular Septal Defect (VSD) repair, this infant's rSO2 values frequently dipped to sub-optimal levels even though vital signs and pulse oximetry remained stable. Nursing and respiratory staff documented bilateral breath sounds throughout the night. By early morning, a critical desaturation of both SpO2 and rSO2 occurred with recovery of SpO2 to only 88% despite increasing FiO2 to 100%. A stat chest x-ray was obtained revealing significant pleural effusion that was then tapped and drained. This improved cardiac output by allowing the heart to pump adequately. Perfusion to the somatic/peri-renal area was observed to have improved, as evidenced by the dramatic rise in somatic rSO2 values. This case demonstrates the adjunct value of site-specific oxygenation data to aid in the detection of low cardiac output syndrome and limited regional perfusion.
|
