Regional cerebral tissue saturation monitoring is frequently used in patients on mechanical cardiac assist devices with the intention to promptly detect critical imbalances between cerebral oxygen delivery and oxygen extraction and ultimately circumvent permanent brain injury. We report a case where an intraparenchymal bleed in the supply zone of the middle cerebral artery—followed by severe hemispherical brain edema, leading to life-threatening intracranial hypertension—escaped cerebral oximetry monitoring using near-infrared spectroscopy. Potential explanations for our observation, as well as the specific limitations of these devices, are discussed.
From the Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, General Hospital Vienna, Medical University of Vienna, Vienna, Austria.
Accepted for publication November 1, 2018.
The authors declare no conflicts of interest.
Address correspondence to Martin Dworschak, MD, MBA, Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, General Hospital Vienna, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria. Address e-mail to email@example.com.