Oxygen Management and Prevention of Cerebral Ischemia
In this chapter, we discuss the current practices, controversies, and current and future research concerning oxygen management of severe traumatic brain injury (TBI) patients in the intensive care unit (ICU). Prevention of secondary injuries is paramount to the care of TBI patients, so understanding the different mechanisms of secondary injury in TBI patients (including ischemia, mitochondrial damage, and free radical formation) will contribute to their prevention, with the ultimate goal of improving neurologic outcomes. Although many of the data regarding brain tissue oxygen monitoring and directed management are still controversial, different techniques and systems used for monitoring have been proven safe and potentially beneficial. Recent studies investigate the unique option of hyperbaric hyperoxia treatment for severely injured TBI patients, with promising early results.
KeywordsTraumatic brain injury Oxygen monitoring Hyperbaric hyperoxia Mitochondrial damage Free oxygen radical generation Ischemia
- 9.Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2016;80(1):6–15.Google Scholar
- 39.Rockswold SB, Rockswold GL, Zaun DA, Zhang X, Cerra CE, Bergman TA, et al. A prospective, randomized clinical trial to compare the effect of hyperbaric to normobaric hyperoxia on cerebral metabolism, intracranial pressure, and oxygen toxicity in severe traumatic brain injury. J Neurosurg. 2010;112(5):1080–94.CrossRefGoogle Scholar
- 40.Rockswold SB, Rockswold GL, Zaun DA, Liu J. A prospective, randomized phase ii clinical trial to evaluate the effect of combined hyperbaric and normobaric hyperoxia on cerebral metabolism, intracranial pressure, oxygen toxicity, and clinical outcome in severe traumatic brain injury. J Neurosurg. 2013;118(6):1317–28.CrossRefGoogle Scholar