Abstract
The Safeguarding the Brains of our smallest Children (SafeBoosC) project was initially established to test the patient-relevant benefits and harms of cerebral oximetry in extremely preterm infants in the setting of a randomized clinical trial. Extremely preterm infants constitute a small group of patients with a high risk of death or survival with brain injury and subsequent neurodevelopmental disability. Several cerebral oximeters are approved for clinical use, but the use of additional equipment may disturb and thereby possibly harm these vulnerable, immature patients. Thus, the mission statement of the consortium is “do not disturb—unless necessary.” There may also be more tangible risks such as skin breakdown, displacement of tubes and catheters due to more complicated nursing care, and mismanagement of cerebral oxygenation as a physiological variable. Other monitoring modalities have relevance for reducing the risk of hypoxic-ischemic brain injury occurring during acute illness and have found their place in routine clinical care without evidence from randomized clinical trials. In this manuscript, we discuss cerebral oximetry, pulse oximetry, non-invasive electric cardiometry, and invasive monitoring of blood pressure. We discuss the reliability of the measurements, the pathophysiological rationale behind the clinical use, the evidence of benefit and harms, and the costs. By examining similarities and differences, we aim to provide our perspective on the use or non-use of cerebral oximetry in newborn infants during intensive care.
Highlights
IntroductionCare of patients during acute illness has improved dramatically during the last 70 years (one point of departure was the polio epidemic in Copenhagen in 1951, where long-term ventilation was established for a large number of patients), and routinely includes electronic continuous monitoring of vital functions and replacement therapy for organ dysfunction
Care of patients during acute illness has improved dramatically during the last 70 years, and routinely includes electronic continuous monitoring of vital functions and replacement therapy for organ dysfunction
Invasive blood pressure monitoring has been readily available in all neonatal intensive care units for many years
Summary
Care of patients during acute illness has improved dramatically during the last 70 years (one point of departure was the polio epidemic in Copenhagen in 1951, where long-term ventilation was established for a large number of patients), and routinely includes electronic continuous monitoring of vital functions and replacement therapy for organ dysfunction. It has typically been developed in a mechanistic, “plumber-like” manner, addressing one problem after the other within the “body-as-a-machine” paradigm. A central element in the process is the randomized controlled trial (RCT)
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