NIRS: a standard of care for CPB vs. an evolving standard for selective cerebral perfusion?

Cerebral oximetry monitoring using near infrared spectroscopy (NIRS) is a potentially important modality for detection of cerebral ischemia. Despite several studies showing improvements in patient outcome with applied NIRS for cardiac surgery, there has been steady but not yet widespread adoption of this technique. However, for patients undergoing aortic arch surgery--a procedure in which direct interruption of flow to cerebral vessels is an inherent risk--a majority of high-volume centers are using cerebral NIRS on a routine basis. This review examines the rationale and efficacy of such applied neuromonitoring and consider factors instrumental in modifying clinical practice in evolving standards of care.