What does Measurement of Brain Tissue pO2, pCO2 & pH add to Neuromonitoring?

  • F. T. Charbel
  • W. E. Hoffman
  • M. Misra
  • T. Nabhani
  • J. I. Ausman
Conference paper
Part of the Acta Neurochirurgica Supplements book series (NEUROCHIRURGICA, volume 75)

Summary

In this paper the rationale behind utilizing the brain tissue measurements of oxygen, carbon dioxide, pH and temperature is evaluated in the context of ischemia. These parameters were measured using an intraparenchymal multi-parametric brain tissue monitor (Paratrend 7). The need to establish the relevance of this type of monitoring becomes acute as further experience is gained using this kind of technology. Our experience with such a device is presented and is illustrated with two clinical cases. The potential caveats and areas of possible future work are also delineated.

Keywords

Brain tissue monitoring pO2 PCO2 pH; brain ischemia 

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References

  1. 1.
    Charbel FT, Hoffman WE, Misra M, Hannigan K, Ausman JI (1997) Cerebral interstitial tissue oxygen tension, pH, HCCK CO2. Surg Neurol 48: 414–417PubMedCrossRefGoogle Scholar
  2. 2.
    Chesler M (1990) The regulation and modulation of pH in the nervous system. Prog Neurobiol 34: 401–427PubMedCrossRefGoogle Scholar
  3. 3.
    Garcia JH, Lassen NA, Weiller C, Sperling B, Nakagawara J (1996) Ischemic stroke and incomplete infarction. Stroke 27: 761–765PubMedCrossRefGoogle Scholar
  4. 4.
    Hoff JT (1978) Resuscitation in focal brain ischemia. Crit Care Med 6: 245–253PubMedCrossRefGoogle Scholar
  5. 5.
    Hoffman WE, Charbel FT, Edelman G, Ausman JI (1997) Brain tissue oxygenation in patients with cerebral occlusive disease and arteriovenous malformation. Br J Anaesth 78: 169–171PubMedCrossRefGoogle Scholar
  6. 6.
    Hoffman WE, Charbel FT, Edelman G (1996) Brain tissue oxygen, carbon dioxide, and pH in neurosurgical patients at risk for ischemia. Anesth Analg 82: 582–586PubMedGoogle Scholar
  7. 7.
    Hoffman WE, Charbel FT, Edelman G, Hannigan K, Ausman JI (1996) Brain tissue oxygen pressure, carbon dioxide pressure and pH during ischemia. Neurol Res 18: 54–56PubMedGoogle Scholar
  8. 8.
    Hoffman WE, Charbel FT, Edelman G, Ausman JI (1997) Brain tissue gases and pH during arteriovenous malformation resection. Neurosurg 40: 294–301CrossRefGoogle Scholar
  9. 9.
    Hoffman WE, Charbel FT, Ausman JI (1997) Cerebral blood flow and metabolic response to etomidate and in ischemia. Neurol Res 19:41–44PubMedGoogle Scholar
  10. 10.
    Kempski O, Staub F. Jansen M, Schodel F, Baethmann A (1988) Glial swelling during extracellular acidosis in vitro. Stroke 19: 385–392PubMedCrossRefGoogle Scholar
  11. 11.
    Kiening KL, Hartl R, Unterberg AW, Schneider GH, Bardt, Lanksch (1997) Brain tissue pO2-monitoring in comatose patients: implications for the therapy Neurol Res 19: 233–240Google Scholar
  12. 12.
    Kraig RP, Pulsinelli WA, Plum F (1986) Carbonic acid buffer changes during complete brain ischemia. Am J Physiol 250: R348–357Google Scholar
  13. 13.
    Meixensberger J, Dings J. Kugnigk H, J, Roosen K (1993) Studies of tissue PO2 in normal and pathological human cortex. Acta Neurochir (Wien) 59: 58–63Google Scholar
  14. 14.
    Meixensberger J, Baunach S, Amschler J, Dings J, Roosen K (1997) Influence of body position on tissue-pO2, cerebral perfusion pressure and intracranial pressure in patients with acute brain injury. Neurol Res 19: 249–253PubMedGoogle Scholar
  15. 15.
    Nicholls D, Atwell D (1990) The release and uptake of excitatory amino acids. Trends Pharmacol Sci 11: 462–468PubMedCrossRefGoogle Scholar
  16. 16.
    Rechncrona S, Hauge HN, Siesjo BK (1989) Enhancement of iron-catalyzed free radical formation by acidosis in brain homogenates: differences in effect by lactic acid and CO2. J Cereb Blood Flow Metab 9: 65–70CrossRefGoogle Scholar
  17. 17.
    Samson D, Batjer H, Bowman G, Mootz L, Krippner WJ, Meyer YJ. Allen BC (1994) A clinical study of temporary arterial occlusion in the management of intracranial aneurysms. Neurosurgery 34: 22–28PubMedCrossRefGoogle Scholar
  18. 18.
    Shapiro HM (1985) Barbiturates in brain ischemia. Br J. Anaesth 57: 82–95PubMedCrossRefGoogle Scholar
  19. 19.
    Siesjo BK (1992a) Pathophysiology and treatment of focal cerebral ischemia. Part I, pathophysiology. J Neurosurg 77: 169–184PubMedCrossRefGoogle Scholar
  20. 20.
    Siesjo BK (1992b) Pathophysiology and treatment of focal cerebral ischemia. Part II, mechanisms of damage and treatment. J Neurosurg 77: 337–354PubMedCrossRefGoogle Scholar
  21. 21.
    Siesjo BK, Zhao Q, Pahlmark K, Siesjo P, Katsura K, Folbergrova J (1995) Glutamate, calcium, and free radicals as mediators of ischemie brain damage. Ann Thorac Surg 59: 1316–1320PubMedCrossRefGoogle Scholar
  22. 22.
    Tombaugh GC, Sapolsky RM (1990) Mechanistic distinctions between excitotoxic and acidotic hippocampal damage in an in vitro model of ischemia. J Cereb Blood Flow Metab 10: 527–535PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 1999

Authors and Affiliations

  • F. T. Charbel
    • 1
  • W. E. Hoffman
    • 1
  • M. Misra
    • 1
  • T. Nabhani
    • 1
  • J. I. Ausman
    • 1
  1. 1.Department of NeurosurgeryUniversity of IllinoisChicagoUSA

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