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Nahinfrarotspektroskopie unter kardiopulmonaler Reanimation und mechanischer Kreislaufunterstützung

Vom Operationssaal auf die Intensivstation

Near-infrared spectroscopy during cardiopulmonary resuscitation and mechanical circulatory support

From the operating room to the intensive care unit

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Zusammenfassung

Hintergrund

Die Nahinfrarotspektroskopie (NIRS) ermöglicht die kontinuierliche Messung der zerebralen regionalen Sauerstoffsättigung (rSO2). Man bekommt dabei ein venös gewichtetes Sättigungssignal, da das venöse Kompartiment 70–75 %, das arterielle 20–25 % und das kapilläre 2,5–5 % des mit Sauerstoff beladenen Hämoglobins in der vom Oxymeter untersuchten Gewebeprobe ausmacht. Im Unterschied zur Pulsoxymetrie benötigt die NIRS-Technologie keinen pulsatilen Flow und ist damit auch unter extrakorporaler Zirkulation, kardiopulmonaler Reanimation (CPR) und Hypothermie einsetzbar.

Ziel der Arbeit

Die Darstellung von Anwendungsmöglichkeiten der zerebralen und somatischen NIRS, insbesondere bei kardiologischen und kardiochirurgischen Patienten während und nach einer kardiopulmonalen Reanimation und im Rahmen des Einsatzes von mechanischen Kreislaufunterstützungssystemen ist das Ziel dieser Arbeit.

Material und Methoden

Hintergrund ist die zu diesem Thema publizierte Literatur (Peer-review-Arbeiten aus PubMed).

Ergebnisse

Aus dem herzchirurgischen Bereich weiß man, dass Interventionen aufgrund von NIRS-Entsättigungen Anzahl und Schwere perioperativer Komplikationen verringern können. Wenn im Rahmen einer CRP trotz maximaler Anstrengungen und ausreichender CPR-Dauer niedrige zerebrale rSO2-Werte persistieren, ist dies ein Indikator für die Aussichtslosigkeit der Bemühungen. Während des Einsatzes von mechanischen Kreislaufunterstützungssystemen stellt NIRS eine zusätzliche Monitoringoption dar.

Diskussion

NIRS stellt eine rasche anwenderfreundliche und nichtinvasive Methode zur Überwachung der rSO2 dar. Die Methode bringt v. a. während und nach einer Reanimation sowie unter mechanischer Kreislaufunterstützung zusätzliche Informationen über die regionale, zerebrale und somatische Gewebeoxygenierung. Inwieweit NIRS als Standardmonitoring im Rahmen der CPR und unter mechanischer Kreislaufunterstützung empfohlen werden kann (Reduktion von Pulskontrollen und damit verbunden der Hands-off-Zeiten während CPR, Outcomeverbesserung) müssen erst größere multizentrische Studien zeigen.

Abstract

Background

Near infrared spectroscopy (NIRS) allows continuous measurement of cerebral regional oxygen saturation (rSO2). It is a weighted saturation value derived from approximately 70–75 % venous, 20–25 % arterial and 2.5–5 % capillary blood. In contrast to pulse oximetry, NIRS is independent of pulsatile flow. Therefore, it is also applicable during extracorporeal circulation, cardiopulmonary resuscitation (CPR), and hypothermia.

Objectives

The purpose of this work is to describe the application of cerebral and somatic NIRS in cardiology and cardiac surgery patients in the operation room, during and after CPR, and during the intensive care unit stay.

Materials and methods

This article is based on peer-reviewed literature from PubMed.

Results

Interventions based on decline of cerebral NIRS values during on-pump cardiac surgery can reduce major organ morbidity and mortality; however, the appearance of a postoperative cognitive dysfunction is scarcely influenced. Persisting of low cerebral oximetry values during resuscitation is a marker for not achieving return of spontaneous circulation under normothermia. NIRS is an additional method for monitoring that can be used during extracorporeal circulation.

Conclusion

NIRS is a rapidly available, user-friendly, and noninvasive method for continuous measurement of rSO2. NIRS provides additional information about tissue oxygenation especially during resuscitation and extracorporeal circulatory assist support. Recommendations concerning the use of NIRS for standard monitoring during resuscitation and mechanical circulatory support are not currently available. Further studies are required to show if use of NIRS can reduce pulse control and hands-off times during resuscitation and if use of NIRS can improve outcome after CPR and mechanical circulatory support.

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  1. Universitätsklinik für Anästhesie und Intensivmedizin, Department für Operative Medizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich

    D. Wally &  Corinna Velik-Salchner

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Wally, D., Velik-Salchner, C. Nahinfrarotspektroskopie unter kardiopulmonaler Reanimation und mechanischer Kreislaufunterstützung. Med Klin Intensivmed Notfmed 110, 621–630 (2015). https://doi.org/10.1007/s00063-015-0012-4

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