Intensive Care Medicine

, Volume 36, Issue 8, pp 1309–1317

Invasive and noninvasive assessment of cerebral oxygenation in patients with severe traumatic brain injury

  • Santiago R. Leal-Noval
  • Aurelio Cayuela
  • Victoria Arellano-Orden
  • Antonio Marín-Caballos
  • Vicente Padilla
  • Carmen Ferrándiz-Millón
  • Yael Corcia
  • Claudio García-Alfaro
  • Rosario Amaya-Villar
  • Francisco Murillo-Cabezas
Original

Abstract

Purpose

The aim of this study is to investigate the relationship between invasive brain tissue oxygen pressure (PbrO2) and noninvasive regional transcranial oxygen saturation (rSO2) in 22 stable patients with severe traumatic brain injury (TBI) during a 16 h period.

Methods

This was a prospective, observational study carried out in the Neurocritical Care Unit of a level 1 trauma center in a teaching hospital. A total of 41,809 paired records for neuromonitoring variables were analyzed and compared.

Results

A direct and independent correlation between rSO2 and PbrO2 was confirmed through adjusted [β coefficient and (95% confidence interval, CI) = 0.36 (0.35–0.37)] and logistic [PbrO2 ≥15 mmHg, as a dependent variable; adjusted odds ratio (AOR) and (95% CI) = 1.11 (1.10–1.12)] regression analyses. A receiver-operating characteristic (ROC) curve demonstrated that rSO2 had low accuracy for detecting moderate (PbrO2 ≤15 mmHg) intracerebral hypoxia [area under curve (AUC) = 0.62], with the likelihood ratio for a positive test (LR+) = 1.2 for an optimal cutoff of rSO2 ≤70%. In contrast, the ROC analysis showed that rSO2 was moderately accurate for detecting severe (PbrO2 ≤12 mmHg) intracerebral hypoxemia (AUC = 0.82; LR+ = 5.3) for an optimal cutoff of rSO2 ≤60%.

Conclusions

In patients with severe TBI, PbrO2 and rSO2 were directly and significantly related. Severe intracerebral hypoxia was better detected by rSO2 than was moderate intracerebral hypoxia. However, the diagnostic accuracy of rSO2 was limited, and this measure should not be considered a substitute for routine PbrO2 monitoring.

Keywords

Brain hypoxia Brain tissue oxygen pressure Cerebral oxygenation Neurotrauma NIRS rSO2 PbrO2 Severe traumatic brain injury and transfusion 

Abbreviations

CPP

Cerebral perfusion pressure

EtCO2

End-tidal CO2

FiO2

Oxygen inspired fraction

GCS

Glasgow Coma Scale

ICP

Intracranial pressure

MAP

Mean arterial pressure

NIRS

Near-infrared spectroscopy

PaO2

Oxygen arterial pressure

PbrO2

Brain tissue oxygen pressure

rSO2

Regional transcranial oxygen saturation

SjO2

Jugular venous oxygen saturation

TCDB

Traumatic Coma Data Bank

TBI

Traumatic brain injury

TEMP

Intracranial temperature

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Santiago R. Leal-Noval
    • 1
    • 3
  • Aurelio Cayuela
    • 2
  • Victoria Arellano-Orden
    • 1
  • Antonio Marín-Caballos
    • 1
  • Vicente Padilla
    • 1
  • Carmen Ferrándiz-Millón
    • 1
  • Yael Corcia
    • 1
  • Claudio García-Alfaro
    • 1
  • Rosario Amaya-Villar
    • 1
  • Francisco Murillo-Cabezas
    • 1
  1. 1.Neuro Critical Care DivisionHospital Universitario “Virgen del Rocío”SevilleSpain
  2. 2.Statistical DivisionHospital Universitario “Virgen del Rocío”SevilleSpain
  3. 3.Servicio de Cuidados Críticos y Urgencias. Instituto de Biomedicina de Sevilla (IBIS)Hospital Universitario “Virgen del Rocío”SevilleSpain

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