Neurocritical Care

, Volume 15, Issue 3, pp 529–536 | Cite as

Continuous Brain Tissue Oxygenation Monitoring in the Management of Pediatric Stroke

  • Baxter B. Allen
  • Caitlin E. Hoffman
  • Chani S. Traube
  • Steven L. Weinstein
  • Jeffrey P. GreenfieldEmail author
Practical Pearl



Direct invasive monitoring of brain tissue oxygenation (PbtO2) has been routinely utilized to predict cerebral ischemia and to prevent secondary injury in patients with traumatic brain injury (TBI) and vasospasm secondary to subarachnoid hemorrhage (SAH). The safety and utility of these devices in the pediatric population have been examined in a few small studies. No studies, however, have examined the use of PbtO2 monitoring in stroke patients.


Retrospective chart review of the first two consecutive, critically ill pediatric patients in the pediatric intensive care unit requiring brain tissue oxygen monitoring for newly diagnosed cerebral ischemia. ICP, CPP, PbtO2, SaO2, BP, and RR were all continually monitored during their care and were retrospectively collected and reviewed.


We present two pediatric stroke patients managed in a critical care setting with PbtO2 monitoring in addition to ICP, MAP, CPP, and SaO2. Both patients had multiple events of low brain tissue oxygen (PbtO2 <20 torr), independent of abnormal values in other monitoring parameters, which required physician intervention. No new ischemic damage occurred after PbtO2 monitoring began in either patient.


There is currently inadequate data to support the application of PbtO2 monitoring in children with stroke to prevent progressive ischemia and to improve outcome. However, the positive results for these two patients support the need for further study in this area.


Cerebral ischemia Brain tissue oxygenation Pediatric stroke Critical care management Stroke Traumatic brain injury Brain injury 


  1. 1.
    Al-Rawi PG, Tseng MY, Richards HK, et al. Hypertonic saline in patients with poor-grade subarachnoid hemorrhage improves cerebral blood flow, brain tissue oxygen, and pH. Stroke. 2010;41:122–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Dings J, Meixensberger J, Jager A, Roosen K. Clinical experience with 118 brain tissue oxygen partial pressure catheter probes. Neurosurgery. 1998;43:1082–95.PubMedCrossRefGoogle Scholar
  3. 3.
    Gelabert-Gonzalez M, Fernandez-Villa JM, Ginesta-Galan V. Intra-operative monitoring of brain tissue O2 (PtiO2) during aneurysm surgery. Acta Neurochir (Wien). 2002;144:863–6. discussion 886–867.CrossRefGoogle Scholar
  4. 4.
    Kett-White R, Hutchinson PJ, Al-Rawi PG, Gupta AK, Pickard JD, Kirkpatrick PJ. Adverse cerebral events detected after subarachnoid hemorrhage using brain oxygen and microdialysis probes. Neurosurgery. 2002;50:1213–21. discussion 1221–1222.PubMedGoogle Scholar
  5. 5.
    Lang EW, Mulvey JM, Mudaliar Y, Dorsch NW. Direct cerebral oxygenation monitoring—a systematic review of recent publications. Neurosurg Rev. 2007;30:99–106. discussion 106–107.PubMedCrossRefGoogle Scholar
  6. 6.
    Meixensberger J, Jaeger M, Vath A, Dings J, Kunze E, Roosen K. Brain tissue oxygen guided treatment supplementing ICP/CPP therapy after traumatic brain injury. J Neurol Neurosurg Psychiatry. 2003;74:760–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Narotam PK, Burjonrappa SC, Raynor SC, Rao M, Taylon C. Cerebral oxygenation in major pediatric trauma: its relevance to trauma severity and outcome. J Pediatr Surg. 2006;41:505–13.PubMedCrossRefGoogle Scholar
  8. 8.
    Stiefel MF, Spiotta A, Gracias VH, et al. Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg. 2005;103:805–11.PubMedCrossRefGoogle Scholar
  9. 9.
    Stiefel MF, Udoetuk JD, Spiotta AM, et al. Conventional neurocritical care and cerebral oxygenation after traumatic brain injury. J Neurosurg. 2006;105:568–75.PubMedCrossRefGoogle Scholar
  10. 10.
    Ushewokunze S, Sgouros S. Brain tissue oxygenation changes in children during the first 24 h following head injury. Childs Nerv Syst. 2009;25:341–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Valadka AB, Gopinath SP, Contant CF, Uzura M, Robertson CS. Relationship of brain tissue PO2 to outcome after severe head injury. Crit Care Med. 1998;26:1576–81.PubMedCrossRefGoogle Scholar
  12. 12.
    van den Brink WA, van Santbrink H, Steyerberg EW, et al. Brain oxygen tension in severe head injury. Neurosurgery. 2000;46:868–76. discussion 876–878.PubMedGoogle Scholar
  13. 13.
    Figaji AA, Fieggen AG, Argent AC, Leroux PD, Peter JC. Does adherence to treatment targets in children with severe traumatic brain injury avoid brain hypoxia? A brain tissue oxygenation study. Neurosurgery. 2008;63:83–91. discussion 91–92.PubMedCrossRefGoogle Scholar
  14. 14.
    Figaji AA, Zwane E, Fieggen AG, et al. Pressure autoregulation, intracranial pressure, and brain tissue oxygenation in children with severe traumatic brain injury. J Neurosurg Pediatr. 2009;4:420–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Figaji AA, Zwane E, Thompson C, et al. Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury. Part 2: relationship with clinical, physiological, and treatment factors. Childs Nerv Syst. 2009;25:1335–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Figaji AA, Zwane E, Thompson C, et al. Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury. Part 1: relationship with outcome. Childs Nerv Syst. 2009;25:1325–33.PubMedCrossRefGoogle Scholar
  17. 17.
    Flynn EP, Auer RN. Eubaric hyperoxemia and experimental cerebral infarction. Ann Neurol. 2002;52:566–72.PubMedCrossRefGoogle Scholar
  18. 18.
    Singhal AB, Dijkhuizen RM, Rosen BR, Lo EH. Normobaric hyperoxia reduces MRI diffusion abnormalities and infarct size in experimental stroke. Neurology. 2002;58:945–52.PubMedGoogle Scholar
  19. 19.
    Singhal AB, Wang X, Sumii T, Mori T, Lo EH. Effects of normobaric hyperoxia in a rat model of focal cerebral ischemia-reperfusion. J Cereb Blood Flow Metab. 2002;22:861–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Singhal AB, Benner T, Roccatagliata L, et al. A pilot study of normobaric oxygen therapy in acute ischemic stroke. Stroke. 2005;36:797–802.PubMedCrossRefGoogle Scholar
  21. 21.
    Singhal AB, Ratai E, Benner T, et al. Magnetic resonance spectroscopy study of oxygen therapy in ischemic stroke. Stroke. 2007;38:2851–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Dani KA, Santosh C, Brennan D, et al. T2*-weighted magnetic resonance imaging with hyperoxia in acute ischemic stroke. Ann Neurol. 2010;68:37–47.PubMedCrossRefGoogle Scholar
  23. 23.
    Hoffman WE, Charbel FT, Gonzalez-Portillo G, Ausman JI. Measurement of ischemia by changes in tissue oxygen, carbon dioxide, and pH. Surg Neurol. 1999;51:654–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Nortje J, Coles JP, Timofeev I, et al. Effect of hyperoxia on regional oxygenation and metabolism after severe traumatic brain injury: preliminary findings. Crit Care Med. 2008;36:273–81. doi: 10.1097/01.CCM.0000292014.60835.15.PubMedCrossRefGoogle Scholar
  25. 25.
    Rangel-Castilla L, Lara LR, Gopinath S, Swank PR, Valadka A, Robertson C. Cerebral hemodynamic effects of acute hyperoxia and hyperventilation after severe traumatic brain injury. J Neurotrauma. 2010;27:1853–63.PubMedCrossRefGoogle Scholar
  26. 26.
    Rosenthal G, Hemphill JC, Sorani M, et al. Brain tissue oxygen tension is more indicative of oxygen diffusion than oxygen delivery and metabolism in patients with traumatic brain injury. Crit Care Med. 2008;36:1917–24.PubMedCrossRefGoogle Scholar
  27. 27.
    Chen HI, Malhotra NR, Oddo M, Heuer GG, Levine JM, LeRoux PD. Barbiturate infusion for intractable intracranial hypertension and its effect on brain oxygenation. Neurosurgery. 2008;63:880–7. doi: 10.1227/01.NEU.0000327882.10629.06.PubMedCrossRefGoogle Scholar
  28. 28.
    Du F, Zhang Y, Iltis I, et al. In vivo proton MRS to quantify anesthetic effects of pentobarbital on cerebral metabolism and brain activity in rat. Magn Reson Med. 2009;62:1385–93.PubMedCrossRefGoogle Scholar
  29. 29.
    Lee S-H, Kim S-Y, Woo D-C, et al. Differential neurochemical responses of the canine striatum with pentobarbital or ketamine anesthesia: a 3T proton MRS Study. J Vet Med Sci. 2010;72:583–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HEM, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. Chapter 8. Cerebral perfusion pressure. Pediatr Crit Care Med. 2003;4:S31–3.PubMedCrossRefGoogle Scholar
  31. 31.
    Severinghaus JW. Determination of PO2 from saturation [reply]. J Appl Physiol. 1989;67:902.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Baxter B. Allen
    • 1
  • Caitlin E. Hoffman
    • 2
  • Chani S. Traube
    • 3
  • Steven L. Weinstein
    • 1
  • Jeffrey P. Greenfield
    • 2
    Email author
  1. 1.Division of Child Neurology, Department of PediatricsWeill Cornell Medical CollegeNew YorkUSA
  2. 2.Department of Neurological SurgeryNew York Presbyterian Hospital, Weill Cornell Medical CollegeNew YorkUSA
  3. 3.Division of Critical Care, Department of PediatricsWeill Cornell Medical CollegeNew YorkUSA

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