Intensive Care Medicine

, Volume 33, Issue 8, pp 1322–1328

Neuromonitoring in the intensive care unit. II. Cerebral oxygenation monitoring and microdialysis

Review

Abstract

Background

Monitoring the injured brain is an integral part of the management of severely brain injured patients in intensive care. There is increasing interest in methods to monitor global and regional cerebral oxygenation. There have been significant advances in analysing tissue oxygenation and local metabolites in the injured brain over the past decade.

Discussion

Cerebral oxygenation can be assessed on a global or regional basis by jugular venous oximetry and near infra-red spectroscopy respectively. Techniques of brain tissue oxygenation monitoring and microdialysis are also covered in this review.

Conclusions

Various modalities are available to monitor oxygenation and the local milieu in the injured brain in the intensive care unit. Use of these modalities helps to optimise brain oxygen delivery and metabolism in patients with acute brain injury.

Keywords

Traumatic brain injury Oximetry, jugular venous Spectroscopy, near-infrared Microdialysis 

Abbreviations

a-vDO2

arteriovenous oxygen content difference

CBF

cerebral blood flow

CMRO2

cerebral metabolic rate of oxygen

CPP

cerebral perfusion pressure

CT

computerised tomography

CytOx

cytochrome aa3

EEG

electroencephalogram

GABA

γ-amino-butyric acid

Hb

haemoglobin (deoxygenated)

HbO2

haemoglobin (oxygenated)

ICP

intracranial pressure

NIRS

near-infrared spectroscopy

PbO2

brain tissue oxygen partial pressure

PbCO2

brain tissue carbon dioxide partial pressure

PET

positron emission tomography

SAH

subarachnoid haemorrhage

SjvO2

jugular venous oxygen saturation

TBI

traumatic brain injury

TCD

transcranial Doppler

TOI

tissue oxygenation index

References

  1. 1.
    Stocchetti N, Paparella A, Bridelli F, Bacchi M, Piazza P, Zuccoli P (1994) Cerebral venous oxygenation studied with bilateral samples in the internal jugular veins. Neurosurgery 34:38–44PubMedCrossRefGoogle Scholar
  2. 2.
    Metz C, Holzschuh M, Bein T, Woertgen C, Rothoerl R, Kallenbach B, Taeger K, Brawanski A (1998) Monitoring of cerebral oxygen metabolism in the jugular bulb: reliability of unilateral measurements in severe head injury. J Cereb Blood Flow Metab 18:332–343PubMedCrossRefGoogle Scholar
  3. 3.
    Obrist WD, Langfitt TW, Jaggi JL, Cruz J, Gennarelli TA (1984) Cerebral blood flow and metabolism in comatose patients with acute head injury: relationship to intracranial hypertension. J Neurosurg 61:245–253Google Scholar
  4. 4.
    Robertson CS, Narayan RK, Gokaslan Z, Pahwa R, Grossman RG, Caram P Jr, Allen E (1989) Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg 70:222–230PubMedGoogle Scholar
  5. 5.
    Robertson CS, Gopinath SP, Goodman JC, Contant CF, Valadka AB, Narayan RK (1995) SjvO2 monitoring in head-injured patients. J Neurotrauma 12:891–896PubMedGoogle Scholar
  6. 6.
    Coles JP, Minhas PS, Fryer TD, Smielewski P, Aigbirihio F, Donovan T, Downey SP, Williams G, Chatfield D, Matthews JC, Gupta AK, Carpenter TA, Clark JC, Pickard JD, Menon DK (2002) Effect of hyperventilation on cerebral blood flow in traumatic head injury: clinical relevance and monitoring correlates. Crit Care Med 30:1950–1959PubMedCrossRefGoogle Scholar
  7. 7.
    Diaz-Reganon G, Minambres E, Holanda M, Gonzalez-Herrera S, Lopez-Espadas F, Garrido-Diaz C (2002) Usefulness of venous oxygen saturation in the jugular bulb for the diagnosis of brain death: report of 118 patients. Intensive Care Med 28:1724–1728PubMedCrossRefGoogle Scholar
  8. 8.
    Fandino J, Kaku Y, Schuknecht B, Valavanis A, Yonekawa Y (1998) Improvement of cerebral oxygenation patterns and metabolic validation of super-selective intraarterial infusion of papaverine for the treatment of cerebral vasospasm. J Neurosurg 89:93–100PubMedGoogle Scholar
  9. 9.
    Cruz J (1996) Adverse effects of pentobarbital on cerebral venous oxygenation of comatose patients with acute traumatic brain swelling: relationship to outcome. J Neurosurg 85:758–761PubMedGoogle Scholar
  10. 10.
    Sheinberg M, Kanter MJ, Robertson CS, Constant CF, Narayan RK, Grossman RG (1992) Continuous monitoring of jugular venous oxygen saturation in head injured patients. J Neurosurg 76:212–217PubMedGoogle Scholar
  11. 11.
    Gupta AK, Hutchinson PJ, Al-Rawi P, Gupta S, Swart M, Kirkpatrick PJ, Menon DK, Datta AK (1999) Measuring brain tissue oxygenation compared with jugular venous oxygen saturation for monitoring cerebral oxygenation after traumatic brain injury. Anesth Analg 88:549–553PubMedCrossRefGoogle Scholar
  12. 12.
    Kirkpatrick PJ, Smielewski P, Czosnyka M, Menon DK, Pickard JD (1995) Near infrared spectroscopy use in patients with head injury. J Neurosurg 83:963–970PubMedGoogle Scholar
  13. 13.
    Kirkpatrick PJ, Smielewski P, Whitfield P, Czosnyka M, Menon D, Pickard JD (1995) An observational study of near infrared spectroscopy during carotid endarterectomy. J Neurosurg 82:756–763PubMedGoogle Scholar
  14. 14.
    Vernieri F, Tibuzzi F, Pasqualetti P, Rosato N, Passarelli F, Rossini PM, Silvestrini M (2004) Transcranial Doppler and near-infrared spectroscopy can evaluate the hemodynamic effect of carotid artery occlusion. Stroke 35:64–70PubMedCrossRefGoogle Scholar
  15. 15.
    Al-Rawi PG, Smielewski P, Kirkpatrick PJ (2001) Evaluation of a Near-Infrared Spectrometer (NIRS 300) for the detection of intracranial oxygenation changes in the adult head. Stroke 32:2492–2500PubMedGoogle Scholar
  16. 16.
    Dunham CM, Sosnowski C, Porter JM, Siegal J, Kohli C (2002) Correlation of noninvasive cerebral oximetry with cerebral perfusion in the severe head injured patient: a pilot study. J Trauma 52:40–46PubMedGoogle Scholar
  17. 17.
    McLeod AD, Igielman F, Elwell C, Cope M, Smith M (2003) Measuring cerebral oxygenation during normobaric hyperoxia: a comparison of tissue microprobes, near-infrared spectroscopy, and jugular venous oximetry in head injury. Anesth Analg 97:851–856PubMedCrossRefGoogle Scholar
  18. 18.
    Gopinath SP, Robertson CS, Constant CF, Narayan RK, Grossman RG, Chance B (1995) Early detection of delayed intracranial haematomas using near-infrared spectroscopy. J Neurosurg 83:438–444PubMedGoogle Scholar
  19. 19.
    Villringer A, Steinbrink J, Obrig H (2004) Cerebral near-infrared spectroscopy: how far away from a routine diagnostic tool? Stroke 35:70–72PubMedCrossRefGoogle Scholar
  20. 20.
    Maas AIR, Fleckenstein W, Dejong DA, Van Santbrink H (1993) Monitoring cerebral oxygenation: experimental studies and preliminary clinical results of continuous monitoring of cerebral spinal fluid and brain tissue oxygen tension. Acta Neurochir Suppl (Wien) 59:50–57Google Scholar
  21. 21.
    Zauner A, Bullock R, Di X, Young HF (1995) Brain oxygen, CO2, pH, and temperature monitoring: evaluation in the feline brain. J Neurosurg 37:1168–1177CrossRefGoogle Scholar
  22. 22.
    Keining KL, Unterberg AW, Bardt TF, Schneider GH, Lanksch WR (1996) Monitoring cerebral oxygenation in patients with head injuries: brain tissue PO2 versus jugular vein saturation. J Neurosurg 85:751–757Google Scholar
  23. 23.
    Kett-White R, Hutchinson PJ, Al-Rawi PG, Gupta AK, Pickard JD, Kirkpatrick PJ (2002) Adverse cerebral events detected after subarachnoid hemorrhage using brain oxygen and microdialysis probes. Neurosurgery 50:1213–1221PubMedCrossRefGoogle Scholar
  24. 24.
    Charbel FT, Du X, Hoffman WE, Ausman JI (2002) Brain tissue PO2, PCO2, and pH during cerebral vasospasm. J Neurosurg 97:1302–1305Google Scholar
  25. 25.
    Gupta AK, Zygun D, Johnston AJ, Steiner LA, Al-Rawi PG, Chatfield D, Shepherd E, Kirkpatrick PJ, Hutchinson PJ, Menon DK (2004) Extracellular brain pH and outcome following severe traumatic brain injury. J Neurotrauma 21:678–684PubMedCrossRefGoogle Scholar
  26. 26.
    Gupta AK, Hutchinson PJ, Al-Rawi P, Gupta S, Swart M, Kirkpatrick PJ, Menon DK, Datta AK (1999) Measurement of brain tissue oxygenation compared with jugular venous oxygen saturation for monitoring cerebral oxygenation after traumatic brain injury. Anesth Analg 88:549–553PubMedCrossRefGoogle Scholar
  27. 27.
    Gupta AK, Hutchinson PJ, Fryer T, Al-Rawi PG, Parry DA, Minhas PS, Kett-White R, Kirkpatrick PJ, Mathews JC, Downey S, Aigbirhio F, Clark J, Pickard JD, Menon DK (2002) Measurement of brain tissue oxygenation performed using positron emission tomography scanning to validate a novel monitoring method. J Neurosurg 96:263–268PubMedGoogle Scholar
  28. 28.
    Menon DK, Coles JP, Gupta AK, Fryer TD, Smielewski P, Chatfield DA, Aigbirhio F, Skepper JN, Minhas PS, Hutchinson PJ, Carpenter TA, Clark JC, Pickard JD (2004) Diffusion limited oxygen delivery following head injury. Crit Care Med 32:1384–1390PubMedCrossRefGoogle Scholar
  29. 29.
    Hutchinson PJ, O'Connell MT, Al-Rawi PG, Maskell LB, Kett-White R, Gupta AK, Richards HK, Hutchinson DB, Kirkpatrick PJ, Pickard JD (2000) Clinical cerebral microdialysis: a methodological study. J Neurosurg 93:37–43PubMedCrossRefGoogle Scholar
  30. 30.
    Whittle IR, Glasby M, Lammie A, Bell H, Ungerstedt U (1998) Neuropathological findings after intracerebral implantation of microdialysis catheters. Neuroreport 9:2821–2825PubMedCrossRefGoogle Scholar
  31. 31.
    Sarrafzadeh AS, Sakowitz OW Keining KL, Benndorf G, Lanksch WR, Unterbrg AW (2002) Bedside microdialysis: a tool to monitor cerebral metabolism in subarachnoid hemorrhage patients? Crit Care Med 30:1062–1070PubMedCrossRefGoogle Scholar
  32. 32.
    Stahl N, Schalen W, Ungerstedt U, Nordstrom CH (2003) Bedside biochemical monitoring of the penumbra zone surrounding an evacuated acute subdural haematoma. Acta Neurol Scand 108:211–215PubMedCrossRefGoogle Scholar
  33. 33.
    Bellander B-M, Cantais E, Enblad P, Hutchinson P, Nordstrom C-H, Robertson CS, Sahuquillo J, Smith M, Stocchetti N, Ungerstedt U, Unterberg A, Vidiendal Olsen NV (2004) Consensus meeting on microdialysis in neurointensive care. Intensive Care Med 30: 2166–2169PubMedCrossRefGoogle Scholar
  34. 34.
    Johnston AJ, Gupta AK (2002) Advanced monitoring in the neurology intensive care unit: microdialysis. Curr Opin Crit Care 8:121–127PubMedCrossRefGoogle Scholar
  35. 35.
    Persson L, Valtysson J, Enblad P, Warme PE, Cesarini K, Lewen A, Hillered L (1996) Neurochemical monitoring using intracerebral microdialysis in patients with subarachnoid hemorrhage. J Neurosurg 84:606–616PubMedCrossRefGoogle Scholar
  36. 36.
    Peerdeman SM, Girbes AR and Vandertop WP (2000) Cerebral microdialysis as a new tool for neurometabolic monitoring. Intensive Care Med 26:662–669PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Department of AnaesthesiaAddenbrooke’s HospitalCambridgeUK
  2. 2.Neuroscience Critical Care UnitAddenbrooke’s HospitalCambridgeUK

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