Current strategies of cerebral oxygenation monitoring in general intensive care units : a narrative review

Abstract

Introduction: Cerebral hypoxia represents the final metabolic consequence of sustained intracranial pressure and impaired autoregulation. Continuous cerebral oxygen monitoring is essential to prevent secondary ischemic injury in neurocritical care particularly in severe traumatic brain injury, malignant infarction, and aneurysmal subarachnoid hemorrhage. It also guides management of systemic disturbances such as shock, sepsis, and respiratory failure and is increasingly used perioperatively in high-risk cardiac, carotid, and neurosurgical procedures. Aim of the study: To synthesize physiological principles, monitoring modalities, and clinical applications of cerebral oxygenation across neurocritical care and perioperative settings, emphasizing bedside interpretation and integration within multimodal neuromonitoring. Materials and Methods: PubMed and Scopus were searched (January 2010–January 2025) using MeSH terms and keywords including “cerebral oxygenation,” “brain tissue oxygen tension,” “jugular bulb saturation,” and “near-infrared spectroscopy.” Fifty-eight English-language studies (randomized controlled trials, observational studies, reviews, and editorials) were included. Non-English publications, animal studies, conference abstracts, unavailable full texts, and non–peer-reviewed articles were excluded. Results: Brain tissue oxygen tension, jugular bulb oximetry, and near-infrared spectroscopy provide complementary insights. Brain tissue oxygen tension is invasive and region-specific (<25 mmHg indicates high risk), jugular bulb oximetry reflects global cerebral oxygen extraction, and near-infrared spectroscopy enables noninvasive regional trend monitoring. Multimodal neuromonitoring integrating these with intracranial pressure, transcranial Doppler, and electroencephalography improves detection and management of secondary ischemia. In neurocritical care, invasive monitoring supports targeted interventions, whereas in ICU and perioperative settings, multimodal strategies balance diagnostic yield and feasibility. Conclusions: Cerebral oxygen monitoring should be routinely implemented in high-risk patients. Multimodal neuromonitoring should be prioritized to detect hypoxia early and guide individualized cerebral perfusion strategies. Near-infrared spectroscopy should be used for continuous monitoring, while invasive modalities should be reserved for high-risk neurocritical patients. Standardized thresholds and protocolized approaches should be established through prospective, outcome-driven research.