Pro: NIRS is “Standard of Care” for Postoperative Management

Abstract

Successful postoperative management depends on early detection and correction of circulatory insufficiency. Global cardiac output and oxygen delivery must be adequate and distributed appropriately to meet metabolic demands to prevent the development of multi-organ dysfunction, morbidity, and death. Decreased cardiac output during the postoperative period is common, but circulatory assessment using standard monitoring provides inadequate information to reliably detect low cardiac output syndrome or effectively guide therapy. Goal-directed therapy using invasive estimates of global oxygen supply-demand balance (SvO2) has been shown to improve survival among patients in shock states. Near infrared spectroscopy (NIRS) is a noninvasive assessment of regional oxygen supply-demand balance. Multiple prospective observational studies have shown that NIRS-derived measures of systemic oxygen balance correlate with global circulatory measures, including SvO2 and biochemical indicators of shock. Additionally, NIRS has been shown in multiple prospective observational studies to identify circulatory inadequacy in specific organ systems, such as the brain, kidney, and gut. NIRS provides continuous, non-invasive measures that are suitable targets for goal-directed therapy to treat deficiencies in global and regional perfusion and should be standard of care.