MedEd Bytes series:

MedEd Bytes is a video series that offers a quick and digestible learning format that can help solidify your understanding of different therapies leveraged in patient monitoring and respiratory interventions. In this series, we’ll cover topics such as capnography waveforms, the technology behind pulse oximetry, modes of ventilation, and more. To stay up to date with the series, please subscribe to our YouTube channel or start watching the series below.

INVOS™ monitoring in the neonatal intensive care unit

Premature neonates may have immature organs with suboptimal functioning — putting them at risk for poor perfusion and oxygen delivery. This may be missed by routine vital sign monitoring that does not capture oxygen supply, demand, or content at the organ level.1 INVOS™️ regional oximetry provides non-invasive real-time monitoring of oxygenation in the tissue beneath the sensor,2 assisting clinicians in limiting patients’ exposure to end-organ hypoxia.1

In this MedEd Bytes series, we will discuss the application of regional oximetry in critically ill neonatal patients.

Byte 1: Individualized care

Individualized care for this patient population ideally would involve assessing perfusion and/or oxygenation of the brain or other tissues and organs to ensure that gas exchange and hemodynamic stability are adequate.3

2:04

Byte 2: Routine monitoring

Usual monitoring of global vital signs, such as heart rate, urine output, cardiac output or blood pressure, may not be adequate to identify regional tissue oxygen desaturation.4

2:37

Byte 3: The INVOS™ system

INVOS™ regional oximetry can  assist clinicians in limiting the burden of end-organ tissue hypoxia.1

2:24

Byte 4: Cerebral monitoring

Cerebral oximetry can detect cerebral hypoxia, which is associated with adverse short or long-term outcome.5

2:37

Byte 5: Somatic monitoring

Decreases in the regional oximetry trend of renal and splanchnic tissue can identify multiple conditions, including the early stages of shock and sepsis, global hypoxia, temperature changes, or compartment syndrome.6–9

3:25

Byte 6: Markers of perfusion and INVOS™ as a first alert

The rSO2 measurement may provide an early and more sensitive warning of hypoperfusion or hypoxia compared to traditional markers of perfusion and oxygenation.1

2:04

Byte 7: Regional oximetry may be independent of global markers of perfusion

Without a direct measure of end-organ oxygen delivery, we may be missing tissue hypoxia or treating patients unnecessarily.1,10

2:15

Byte 8: Guiding treatment of cerebral desaturation with INVOS™

To improve cerebral oxygenation, you can increase oxygen delivery, increase arterial oxygen content, or you can decrease oxygen use.11,9

1:46

Byte 9: NIRS as a signal of hypocarbia-induced cerebral vasoconstriction

This case report demonstrates the value of monitoring regional oxygen saturation, which shows the changes in the tissue beds of interest in response to clinical interventions.12

2:23

Byte 10: NIRS to detect the hemodynamic impact of mechanical ventilation

In this case report, clinicians were able to decrease the amount the ventilator support and avoid additional doses of vasopressors, while maintaining adequate cerebral and somatic oxygenation, using the information from NIRS monitoring.13

3:18

Byte 11: NIRS as a guide to manage hemodynamic instability and shock

Somatic desaturation may serve as an early indicator of shock, by alerting clinicians to the  redistribution of blood flow that occurs with the onset of hemodynamic instability.14

2:21

Byte 12: NIRS to detect transfusion requirements

The baseline difference between splanchnic and cerebral oxygen saturation may be a marker of transfusion requirements.15

2:24

Byte 13: NIRS to detect renal hypoperfusion

Renal rSO2 has the potential to identify kidney hemodynamic dysfunction in preterm infants on the first day of life.16

2:31