Continuous Brain Tissue Oxygenation Monitoring in the Management of Pediatric Stroke
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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.
KeywordsCerebral ischemia Brain tissue oxygenation Pediatric stroke Critical care management Stroke Traumatic brain injury Brain injury
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