Abstract
We investigated the role of near infrared spectroscopy (NIRS) in identifying delayed cerebral ischemia (DCI) in patients with subarachnoid hemorrhage (SAH). We measured the cerebral regional oxygen saturation (rSO2) continuously for 14 days. The differences in rSO2 according to DCI were analyzed. We also compared the diagnostic accuracy of NIRS and transcranial Doppler ultrasonography (TCD) for DCI detection using the area under receiver operator characteristic (ROC) curve. Fifty-two patients treated with coil embolization were enrolled, including 18 with DCI (34.6%) and 34 without DCI (65.4%). Significant differences in rSO2 levels were observed from days 7 to 9. The rSO2 level was 60.95 (58.10–62.30) at day 7 in the DCI vs. 63.90 (62.50–67.10) in the non-DCI patients. By day 8, it was 59.50 (56.90–64.50) in the DCI vs. 63.30 (59.70–68.70) in the non-DCI cases. By day 9, it was 61.85 (59.40–65.20) in the DCI vs. 66.00 (62.70–68.30) in the non-DCI. A decline of >12.7% in SO2 rate yielded a sensitivity of 94.44% (95% CI: 72.7–99.9%) and a specificity of 70.59% (95% CI: 52.5–84.9%) for identifying DCI. Changes in NIRS tended to yield better diagnostic accuracy than TCD, but were not statistically significant. NIRS is a feasible method for real-time detection of DCI.
Highlights
Delayed cerebral ischemia (DCI) is a well-known risk factor for serious neurologic complications following subarachnoid hemorrhage (SAH) [1]
A simple noninvasive, robust, and continuous monitoring method for bedside assessment of cerebral ischemia status is required for patients with SAH who are at high risk for DCI
We included SAH patients from this database, who were screened for DCI using an Near-infrared spectroscopy (NIRS) device based on in vivo optical spectroscopy (INVOS) system (INVOS, Somanetics Corp, Troy, MI, USA)
Summary
Delayed cerebral ischemia (DCI) is a well-known risk factor for serious neurologic complications following subarachnoid hemorrhage (SAH) [1]. A simple noninvasive, robust, and continuous monitoring method for bedside assessment of cerebral ischemia status is required for patients with SAH who are at high risk for DCI. NIRS has been widely used to monitor brain oxygenation during cardiac or carotid surgery [3]. A reduction in cerebral regional oxygen saturation (rSO2) greater than 20% or levels below 50–60% is associated with hypoxic or ischemic injury [5,6]. Levy et al [6] reported that the ischemic threshold of rSO2 was 47% in 10 patients during ventricular fibrillation.
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