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.
Insufficient Anesthetic
This case study shows an adult patient undergoing cardiac surgery. Upon initiation of bypass, the patient's cerebral rSO2 values dropped 20% and then slowly declined another 25% during most of the 90 minute surgery. Blood was administered as an intervention and surprisingly provided no changes in rSO2. Anesthetic agent was increased and within three minutes, the rSO2 values rose dramatically by approximately 30%. During rewarming, rSO2 levels dipped again. Once off bypass, this patient's rSO2 values stabilized at a normal level. This case shows how rSO2 responded to inadequate anesthesia as well as the effect of interventions.
Effect of Transfusion on rSO2
There were several times during this Aortic Root Replacement on an elderly patient where anesthesia and perfusion clinicians made interventions. When the patient was placed on CPB, the cerebral rSO2 values dropped while other vital signs were normal. The perfusionist decided to draw blood to check the hemoglobin level after all other interventions were made. The hgb was found to be 7.0 gm/dl and the decision was made to provide the patient with packed red blood cells. Immediately, the blood transfusion increased the patient's cerebral rSO2 values.
Cerebral rSO2 Asymmetry During Aortic Valve Replacement
This Aortic Valve Replacement (AVR) surgery on an elderly patient shows cerebral asymmetry that occurred in a patient with no known history of vascular disease. The perfusionist intervened and aggressively treated the patient's declining, asymmetric rSO2 values. After adjustments were made to flow rate, FiO2, temperature, gas sweep and phenylephrine was given, the downward cerebral trend was reversed, returning the rSO2 levels to baseline. This case illustrates that patients can have left and right cerebral rSO2 asymmetry, with no evidence of vascular disease. Bilateral desaturation was treated aggressively when the 20% intervention threshold is reached. Cardiopulmonary bypass pump flow was managed to provide adequate tissue perfusion to the brain.
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