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Oxymétrie cérébrale

Brain oxymetry

  • Enseignement Supérieur en Réanimation
  • Published:
Réanimation

Résumé

Le monitorage régional de l’oxymétrie cérébrale fait appel à deux technologies. La spectroscopie dans le proche infrarouge (NIRS), qui est non invasive, permet théoriquement de mesurer la saturation en oxygène de l’hémoglobine du lit vasculaire cérébral (ScO2). La seconde est la mesure invasive par électrode polarographique de Clarck de la pression interstitielle du tissu cérébral (PtiO2). Malgré des progrès technologiques, la NIRS ne permet pas de mesurer exclusivement la saturation du sang cérébral et son signal est fortement affecté par la saturation du sang extracrânien. La mesure invasive de la PtiO2 est fiable et a permis d’identifier de fréquents épisodes d’hypoxie tissulaire cérébrale non liée aux déterminants connus du transport cérébral de l’O2. L’intégration de la mesure de la PtiO2 au monitorage multimodal invasif a ainsi permis d’identifier une nouvelle entité pathologique impliquée dans l’ischémie cérébrale secondaire.

Abstract

Two main technologies have been proposed to monitor cerebral oxymetry. Near infrared spectroscopy (NIRS) is a non invasive device theoretically dedicated to measure cerebral blood oxygen saturation (ScO2). The second device allows the invasive measurement of interstitial O2 partial pressure in brain tissue (PtiO2). Despite improvements in technologies, NIRS does not allow to measure exclusively cerebral blood saturation since NIRS signal is strongly affected by extracranial tissue blood saturation. In contrast, the invasive measurement of PtiO2 is reliable and allowed to identify frequent episodic cerebral hypoxic injuries unrelated to known determinants of cerebral O2 transport. Interestingly, integration of PtiO2 measurement in multimodal monitoring allowed the identification of a new pathologic entity involved in secondary cerebral ischemic insults.

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Authors and Affiliations

  1. Centre hospitalier universitaire, 4 rue Larrey, F-49933, Angers, France

    A. Ter Minassian, A. Azau & F. Duc

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  1. A. Ter Minassian
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  2. A. Azau
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  3. F. Duc
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Correspondence to A. Ter Minassian.

Additional information

Cet article correspond à la conférence faite par l’auteur au congrès de la SRLF 2013 dans la session: Monitorage des patients cérébrolésés.

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Ter Minassian, A., Azau, A. & Duc, F. Oxymétrie cérébrale. Réanimation 22 (Suppl 2), 403–408 (2013). https://doi.org/10.1007/s13546-012-0540-3

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  • DOI: https://doi.org/10.1007/s13546-012-0540-3

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