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What is the INVOS® System?
The INVOS® (In-Vivo Optical Spectroscopy) Cerebral/Somatic Oximeter is an FDA-cleared noninvasive patient monitor that has one job: to measure changes in oxygen levels beneath the sensor to protect the brain and vital organ areas from damage. With INVOS® System monitoring, doctors and nurses can detect and correct oxygenation threats before they become catastrophic events, such as brain injury.
Why is it used on the brain and the body?
Since the brain is the organ least tolerant to oxygen deprivation, use of this monitor can help protect patients against devastating brain injury that can last a lifetime and take a huge toll financially. Oxygen problems that lead to such injury often have no outward signs. They can brew silently over time and go undetected until damage has already been done.
When symptoms do appear, they most often surface in the periphery (i.e., in the body, such as kidney failure or a change in cardiac output, which is the amount of blood pumped by the heart), because the body's natural defense is to sacrifice itself to preserve the brain. Therefore, INVOS® System monitoring of site-specific somatic (body) areas can help detect oxygenation problems in their earliest stages. Clinicians will often see the somatic oxygenation values on the INVOS® System drop first, prompting interventions to correct the issue before brain oxygen is compromised.
Similarly, cerebral monitoring provides a direct measure of the changes in brain oxygenation, and this can provide an earlier warning than whole body measures like heart rate, temperature or blood pressure. Used in tandem, cerebral/somatic monitoring via the INVOS® System is a powerful combination to the early detection of brewing complications.
How does the INVOS® System work?
The INVOS® System uses near-infrared spectroscopy, also known as NIRS, a noninvasive technology. The sensors simply stick to the skin like a Band-Aid®. Once the sensor is placed on the skin, harmless, near-infrared light is emitted which passes through the skin and bone to monitor the blood oxygen level of deeper tissue, such as the brain, organs and muscle tissue. Care teams can place up to four sensors on a patient. The vital sign generated is called regional oxygen saturation, or rSO2. The care team tries to maintain the rSO2 within a healthy range. When they see rises and falls in the number, they administer a number of interventions to try and restore adequate oxygenation.
What scientific data backs the efficacy of the INVOS® System?
There are more than 600 presentations, study abstracts and published papers on INVOS® System technology, making it the clinical reference standard in cerebral/somatic oximetry. For adults, benefits reported include reductions in major organ morbidity or mortality, stroke, post-operative cognitive difficulties, respiratory failure/ventilation time, adverse cardiac events and coma. For children, infants and neonates, benefits shown include enhanced detection of oxygen threats associated with low cardiac output, renal failure, neurologic damage, shock and seizures.
Who uses the INVOS® System?
Since the INVOS® System may be used in any clinical setting, users in each hospital may vary and include a wide range of specialties:
- Pediatric and neonatal intensive care nurses
- Surgeons (adult, pediatric and neonatal), primarily cardiac or vascular
- Cardiac intensivists
- Anesthesiologists
- Perfusionists
- Interventional cardiac cath lab clinicians
When does it get used and on whom?
The INVOS® Cerebral/Somatic Oximeter is primarily used in cardiac and vascular surgery as well as in the intensive care unit. The INVOS® System can be used on adult, pediatric, infant and neonatal patients who are deemed at risk of reduced-flow or no-flow ischemic states by the clinician. It may be used in all areas of the hospital, with the most common being the operating room, pediatric and neonatal intensive care units, interventional cardiac catheterization labs and emergency room.
What causes oxygenation problems for patients?
Oxygenation problems are not typically caused by errors in treatment. Instead, oxygen deprivation is an inherent part of many disease states (such as congenital heart defects) and may be a byproduct of certain treatments such as surgery and ventilation. For example, standard surgical tools and techniques can impact oxygenation; from the positioning of the head; to anesthesia dosage; to the clamping of arteries. All of these things have the potential to impact oxygen supply to the brain.
Oxygenation challenges can also come from the patient's own physiology and disease state. And sometimes the extent of these things cannot be identified at the time of surgery or intensive care, meaning care teams can't always predict who is most at risk for developing complications.
What complications may patients be at risk for due to oxygen desaturation?
Oxygen-related complications vary depending on the patient's diagnosis. For example, complications in adult cardiac surgery include major organ morbidity or mortality, stroke, post-operative neurological difficulties, respiratory failure, adverse cardiac events and coma. For children and babies in intensive care, complications can include kidney failure, brain damage, shock and seizures.
How does the INVOS® System differ from other vital sign monitors?
The INVOS® System is unique in that it allows doctors to measure site-specific oxygen levels, rather than relying on an indirect, whole body measures like heart rate, temperature, blood pressure or urine output. Instead, doctors can place up to four sensors on the exact areas they want to track.
To enhance patient safety, early detection and positive patient outcomes, the INVOS® System offers unique clinical value over many traditional patient assessment metrics. These include:
- Site-specific oxygenation data rather than whole body
- Continuous readings rather than intermittent
- Real-time readings rather than time-delayed by labs
- Concrete data rather than subjective assessment
- Immediate data showing the effectiveness of interventions, rather than a "wait and see" method
Where is the INVOS® System available?
The INVOS® System is in use at 700 U.S. hospitals, including 80 percent of centers performing pediatric cardiac surgery, with an additional 1,200+ installs internationally. Outside the U.S., Edwards Lifesciences represents INVOS® System products in Japan, and Covidien (previously Tyco Healthcare) markets INVOS® System products in Europe, Canada, the Middle East and South Africa.
How much does the INVOS® System cost? The INVOS® System costs $30,000 - a cost figure that could be on par with the cost of care should these life-changing or life-threatening complications occur. Disposable sensors list at $280-$390 per pair (depending on the sensor type), which may be discounted for high volume orders.
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