CEREBRAL OXIMETRY

BASICS
• estimates regional tissue oxygenation (rSO2)
by transcutaneous measurement of the
frontal cortex
• uses method of light transmission &
absorption to measure O2Hb:HHb in cerebral
hemispheres
• uses near-infrared spectroscopy (NIRS)
without plethysmography
THE MACHINE
PROBE PLACEMENT
 CEREBRAL OXIMETRY

HbO2
• SO2 = X 100 • ALL represent cerebral
HbO2 + HHb oxygenation :

 rSO2

 ScO2

 SctO2

 TOI (tissure oxygenation

index)
READING THE NUMBERS
• normal rSO2 = 60 % to 80 %
• lower values of 50% are
NOT abnormal in specific
populations
• 20 % threshold from
baseline  ischemic
threshold
• ALWAYS get baseline
reading pre-induction
INTERPRETING THE NUMBERS
Factors that reduce rSO2 values
CBF O2 content

CO Hgb concentration

acid-base status Hgb saturation

hemorrhage pulmonary function

arterial inflow/venous outflow FiO2 concentration

obstruction
MANAGING THE NUMBERS
HR

cerebral
BP PaCO2
rsO2

SaO2
MANAGING THE NUMBERS

normal rSO2/
rSO2
rSO2

address contributing
no intervention variables
necessary
BP, HR, PaCO2, SaO2
MANAGING THE NUMBERS
CAUSE of rSO2 MANAGEMENT
CBF / CPP arterial blood pressure /
PaCO2
PaO2 FiO2

Hgb consider transfusion

metabolism sedation, brain

temperature
 O2Hbi (change in oxyhemoglobin) HHbi (change in deoxyhemoglobin)

O2 delivery CMRO2

Normal
NIRS
 HHbi
• an index of relative change in DEOXYGENATED
hemoglobin

O2 consumption
✔️ hypoxia
✔️ venous congestion
✔️ venous obstruction
✔️ increase in CMRO2
 O2Hbi
• an index of relative change in OXYGENATED
hemoglobin
• reflects changes in O2 delivery

✔️ CBF
✔️ vasodilation
✔️ pCO2
✔️ hemoglobin
✔️ FiO2
 cHbi
• an index of relative change in TOTAL hemoglobin
• reflects changes in cerebral blood volume

BRAIN ISCHEMIA BRAIN HYPOXEMIA

arterial blood flow O2Hbi in the artery
O2Hbi
HHbi
cHbi ↔️
rSO2
THANK YOU!