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Table 1 Learning objectives and questions for the training module on NIRS monitoring

From: Pilot test of an online training module on near-infrared spectroscopy monitoring for the randomised clinical trial SafeBoosC-III

Learning objectiveQuestion
Point out differences between NIRS tissue oxygenation (rStO2) and pulse oximetryA father of a very preterm infant asks why the cerebral rStO2 is 65 when the SpO2 is 94. What do you tell him?
A baby is pale and mottled and you suspect circulatory failure due to septic shock. You have a hard time getting a signal from the pulse oximeter, but the NIRS gives readings with no apparent problems. Choose the correct statement(s)
Recognise the consequences of rStO2 being a direct measure of cerebral oxygen consumption/supply balance and indirect measure of cardiac outputA tiny infant is accidentally extubated and the SpO2 drops from 95% to 75%. Meanwhile, the rStO2 only drops from 70% to 60%. The attending doctor thinks the NIRS might be wrong. What do you tell him?
A colleague asks for help to understand what rStO2 really measures. Which of the following statements would you include in your explanation
You care for a baby in the experimental group on the first day of life. Everything has been stable when the rStO2 alarm goes off and shows cerebral hypoxia. No other monitors are sounding an alarm. The ventilator runs normally, the SpO2 is stable around 92% and the mean arterial blood pressure is stable around 28 mmHg. As you look into the incubator to check the cerebral oximeter sensor you see that he has been bleeding from the umbilicus. It is a large spot on the linen and in the diaper and you estimate that the volume may be 10 ml. Could that be the explanation for the cerebral hypoxia?
Know the elements in starting up NIRS monitoring and interpret values during monitoringYou move the sensor to the other side of the forehead of a sick preterm infant as part of routine care. The parents notice that rStO2 is about 7 percentage points higher in the new position. What answers can you give them?
rStO2 drops suddenly to 40%. What would you do? Please prioritise the following actions from first to last
You have to start up monitoring cerebral oxygenation. Which of the following actions would you not do?
Know the side effects of NIRS monitoringThe parents ask if there are side effects to the near-infrared light used by the oximeter. Choose which statements you may include in your explanation
You take over the care of a baby in the SafeBoosC trial. He is in the experimental group. Gestational age is 24 weeks and he is mechanically ventilated with high pressures and on high dose pressor (dopamine 15 microgram/kg/min) and yet the mean arterial blood pressure is only 24 mmHg. The situation, however, has been stable for the last 12 h. The cerebral oximeter seems to work well and the rStO2 is 65% (the hypoxic threshold of your oximeter is 58%). Choose what you will do?
A mother notices a minor mark on the skin after you have moved the pulse oximeter sensor to another position. She is now concerned about the NIRS sensor as well. What answers can you give her?