Physiology, intervention, and outcome: three critical questions about cerebral tissue oxygen saturation monitoring

The balance between cerebral tissue oxygen consumption and supply can be continuously assessed by cerebral tissue oxygen saturation (SctO2) monitor. A construct consisting of three sequential questions, targeting the physiology monitored, the intervention implemented, and the outcomes affected, is proposed to critically appraise this monitor. The impact of the SctO2-guided care on patient outcome was examined through a systematic literature search and meta-analysis. We concluded that the physiology monitored by SctO2 is robust and dynamic, fragile (prone to derangement), and adversely consequential when deranged. The inter-individual variability of SctO2 measurement advocates for an intervention threshold based on a relative, not absolute, change. The intra-individual variability has multiple determinants which is the foundation of intervention. A variety of therapeutic options are available; however, none are 100% efficacious in treating cerebral dys-oxygenation. The therapeutic efficacy likely depends on both an appropriate differential diagnosis and the functional status of the regulatory mechanisms of cerebral blood flow. Meta-analysis based on five randomized controlled trials suggested a reduced incidence of early postoperative cognitive decline after major surgeries (RR= 0.53; 95% CI: 0.33-0.87; I2 =82%; P=0.01). However, its effects on other neurocognitive outcomes remain unclear. These results need to be interpreted with caution due to the high risks of bias. Quality RCTs based on improved intervention protocols and standardized outcome assessment are warranted in the future.