HASTANE ÖNCESİ YAKLAŞIMI ETKİLEYEN ÖNEMLİ BİR PARAMETRE: SEREBRAL OKSİJEN SATÜRASYONU

Öz

Hastane öncesi olgularda nörolojik sonuçları tahmin etmede güvenilir yöntemler yetersizdir. Geleneksel karar kuralları doku hipoksisini belirlemede ve hemodinamideki değişimleri ön görmede çoğu zaman geç kalmaktadır. Daha etkili nörolojik muayene yöntemlerinin benimsenmesi nörolojik sonuçları iyileştirmeye ve her hasta için terapötik müdahaleleri optimize etmeye yardımcı olacaktır. Nörolojik izlem aracı olan serebral oksimetre, beyin dokusunu doğrudan izlemeye ve değerlendirmeye olanak sağlamakta, noninvaziv teknikle serebral oksijen satürasyonu hakkında bilgi vermektedir. Hastane öncesi serebral oksijen satürasyonu takibinin ise kardiyopulmoner resüsitasyon sırasında nöroprotektif tedavi stratejilerine rehberlik edebileceği ve kardiyopulmoner resüsitasyon protokollerine entegre edilebileceği bildirilmektedir.

Anahtar Kelimeler

• Hastane Öncesi
• Serebral Oksijen Satürasyonu
• Serebral Oksimetre

An Important Parameter Affecting Prehospital Approach: Cerebral Oxygen Saturation

Öz

In prehospital cases, reliable methods for predicting neurological outcomes are insufficient. Traditional decision rules often fall short in detecting tissue hypoxia and predicting changes in hemodynamics in a timely manner. Adopting more effective neurological assessment methods can help improve neurological outcomes and optimize therapeutic interventions for each patient. Cerebral oximetry, a neurological monitoring tool, allows for direct monitoring and evaluation of brain tissue, providing information on cerebral oxygen saturation through a non-invasive technique. Monitoring cerebral oxygen saturation in the prehospital setting has been reported to potentially guide neuroprotective treatment strategies during cardiopulmonary resuscitation and can be integrated into cardiopulmonary resuscitation protocols.

Anahtar Kelimeler

• Prehospital
• Cerebral Oxygen Saturation
• Cerebral Oximeter

Kaynakça

1. Badjatia, N, Carney, N, Crocco, TJ, et al. (2008). Guidelines for Prehospital Management of Traumatic Brain Injury. Prehospital Emergency Care, 12(1):1‐52.
2. Barud, M, Dabrowski, W, Gieroba-Siwicka, D, Robba, C, Bielacz, M, Badenes, R. (2021). Usefulness of Cerebral Oximetry in TBI by NIRS. Journal of Clinical Medicine, 30;10(13):2938.
3. Calderon-Arnulphi, M, Alaraj, A, Slavin, K.V. (2009). Near Infrared Technology in Neuroscience: Past, Present and Future. Neurological Research, 31:605–614.
4. Çelik, EC, Çiftçi, B. (2018). Serebral Oksimetre ve Anestezi Altında Uygulama Alanları. İstanbul Tıp Fakültesi Dergisi, 81(1): 33-36.
5. Denault, A, Deschamps, A, Murkin, J. (2008). A Proposed Algorithm for the Intraoperative Use of Cerebral Near-Infrared Spectroscopy. Seminars in Cardiothoracic and Vascular Anesthesia, 11(4):274-281. Dias, C, Maia, I, Cerejo, A, Smielewski, P, Paiva, J.A, Czosnyka, M. (2016). Plateau Waves of Intracranial Pressure and Multimodal Brain Monitoring. Acta Neurochirurgica Supplement, 122:143–146. Drennan, IR, Gilgan, J, Gancharenka, K, Lin, S. (2019). Use of Near-Infrared Spectroscopy by Paramedics During Out-of-Hospital Cardiac Arrest: A Feasibility Study. Emerging Evidence, 16(5):256-260.
6. Fellahi, J.L, Butin, G, Fischer, M.O, Zamparini, G, Gérard, J.L, Hanouz, JL. (2013). Dynamic Evaluation of Near-Infrared Peripheral Oximetry in Healthy Volunteers: A Comparison Between INVOS and EQUANOX. Journal of Critical Care, 28(5):881.
7. Genbrugge, C, Dens, J, Meex, I, et al. (2015). Regıonal Cerebral Oxımetry Durıng Cardıopulmonary Resuscıtatıon: Useful or Useless? The Journal of Emergency Medicine, 50(1):198-207. Ghosh, A, Elwell, C, Smith, M. (2012). Review Article: Cerebral Near-Infrared Spectroscopy in Adults: A Work in Progress. Anesthesia Analgesia,115(6),1373-1383.
8. Guo, X, Dye, J. (2023). Modern Prehospital Screening Technology for Emergent Neurovascular Disorders. Advanced Biology, 7(10).

9. Kalkan, A, Ersunan, G, Bilir, Ö ve ark. (2014). Near Infrared Spectrophotometry (cerebral oximetry) in Predicting the Return of Spontaneous Circulation in out-of-Hospital Cardiac Arrest. The American Journal of Emergency Medicine, 32(1):14-17.
10. Kaya, C, Er, MC. (2018). Yakın Kızılötesi Spektroskopisi ile Ölçülen Rejyonel Serebral Oksijen Satürasyonu: Sistematik Bir Derleme. Bozok Tıp Dergisi, 8(1):125-30.
11. Kartal Günen, H. (2023). Hastane Öncesi Yaklaşımı Etkileyen Bir Parametre: Kapiller Laktat Ölçümü. Hastane Öncesi Dergisi, 8(2), 203-212.
12. Koyama, Y, Wada, T, Lohman BD, et al. (2013). A New Method to Detect Cerebral Blood Flow Waveform in Synchrony with Chest Compression by Near-Infrared Spectroscopy During CPR. The American Journal of Emergency Medicine, 31(10):1504-1508.
13. Newman, DH, Callaway, CW, Greenwald, IB, et al. (2004). Cerebral Oximetry in out-of-Hospital Cardiac Arrest: Standard CPR Rarely Provides Detectable Hemoglobin-Oxygen Saturation to the Frontal Cortex. Resuscitation, 63(2):189–194.
14. Parnia, S. (2017). Cerebral Oximetry Leading up to Cardiac Arrest: A Marker of the Impact of Mean Arterial Pressure on the Brain, But Not Time of Death. Resuscitation, 121,1-14.
15. Parnia, S, Nasir, A, Shah, C, Patel, R, Mani, A, Richman, P. (2012). A Feasibility Study Evaluating the Role of Cerebral Oximetry in Predicting Return of Spontaneous Circulation in Cardiac Arrest. Resuscitation, 83(8):982-985.
16. Parnia, S, Yang, J, Nguyen, R, Ahn, A, Zhu, J, Inigo-Santiago, L, et al. (2016). Cerebral Oximetry During Cardiac Arrest: A Multicenter Study of Neurologic Outcomes and Survival. Critical Care Medicine, 44:1663–1674.
17. Sknifvars, MB, Aneman, A. (2020). How Near is Near İnfrared Spectroscopy in Pre‐Hospital Care? Acta Anaesthesiologica Scandinavica, 64(1):2-3.
18. Steppan, J, Hogue, CW, Jr. (2014). Cerebral and Tissue Oximetry. Best Practice Research Clinical Anaesthesiology, 28(4),429-439.
19. Stocchetti, N, Carbonara, M, Citerio, G, et al. (2017). Severe Traumatic Brain Injury: Targeted Management in the Intensive Care Unit. Lancet Neurology. 16:452‐464. Takegawa, R, Hayashida, K, Rolston, D, et al. (2020). Near-Infrared Spectroscopy Assessments of Regional Cerebral Oxygen Saturation for the Prediction of Clinical Outcomes in Patients With Cardiac Arrest: A Review of Clinical Impact, Evolution, and Future Directions. Frontiers in Medicine, 29(7). 587930.
20. Taussky, P, O'Neal, B, Daugherty, WP, et al. (2012). Validation of Frontal Near-İnfrared Spectroscopy as Noninvasive Bedside Monitoring for Regional Cerebral Blood Flow in Brain Injured Patients. Neurosurgical Focus, 32(2): E2.
21. Weatherall, A, Skowno, J, Lansdown, A, Lupton, T, Garner, A. (2012). Feasibility of Cerebral Near-Infrared Spectroscopy Monitoring in the Pre-Hospital Environment. Acta Anaesthesiologica Scandinavica, 56:172–177.
22. Wik, L. (2016). Near-Infrared Spectroscopy During Cardiopulmonary Resuscitation and After Restoration of Spontaneous Circulation: A Valid Technology? Current Opinion in Critical Care, 22(3):191-198.
23. Zhong, W, Ji, Z, Sun, C. (2021). A Review of Monitoring Methods for Cerebral Blood Oxygen Saturation. Healthcare, 26;9(9):1104.