Brain Tissue Oxygen Monitoring in Neurocritical Care

  • P. Geukens
  • M. Oddo
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM, volume 2012)

Abstract

Avoidance of secondary cerebral hypoxia/ischemia is a mainstay of therapy in neurocritical care. On-line monitoring of brain tissue oxygen tension (PbtO2) enables detection of secondary brain hypoxic/ischemic insults and targeting of therapeutic interventions, such as intracranial pressure (ICP) control, cerebral perfusion pressure (CPP) augmentation, blood transfusion, and ventilation. Emerging evidence shows that compared to standard ICP/CPP management, PbtO2-directed therapy may improve outcomes of selected populations of brain-injured patients. Larger prospective multicenter trials are underway to further evaluate the potential benefit of PbtO2-directed therapy.

Keywords

Traumatic Brain Injury Cerebral Perfusion Pressure Severe Traumatic Brain Injury Brain Hypoxia Brain Oxygen 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Dings J, Meixensberger J, Jager A, Roosen K (1998) Clinical experience with 118 brain tissue oxygen partial pressure catheter probes. Neurosurgery 43: 1082–1095PubMedCrossRefGoogle Scholar
  2. 2.
    van den Brink WA, van Santbrink H, Steyerberg EW, et al (2000) Brain oxygen tension in severe head injury. Neurosurgery 46: 868–876PubMedGoogle Scholar
  3. 3.
    Menon DK, Coles JP, Gupta AK, et al (2004) Diffusion limited oxygen delivery following head injury. Crit Care Med 32: 1384–1390PubMedCrossRefGoogle Scholar
  4. 4.
    Rosenthal G, Hemphill JC 3rd, Sorani M, et al (2008) Brain tissue oxygen tension is more indicative of oxygen diffusion than oxygen delivery and metabolism in patients with traumatic brain injury. Crit Care Med 36: 1917–1924PubMedCrossRefGoogle Scholar
  5. 5.
    Longhi L, Pagan F, Valeriani V, et al (2007) Monitoring brain tissue oxygen tension in brain-injured patients reveals hypoxic episodes in normal-appearing and in peri-focal tissue. Intensive Care Med 33: 2136–2142PubMedCrossRefGoogle Scholar
  6. 6.
    Gupta AK, Hutchinson PJ, Al-Rawi P, et al (1999) Measuring brain tissue oxygenation compared with jugular venous oxygen saturation for monitoring cerebral oxygenation after traumatic brain injury. Anesth Analg 88: 549–553PubMedGoogle Scholar
  7. 7.
    Scheufler KM, Rohrborn HJ, Zentner J (2002) Does tissue oxygen-tension reliably reflect cerebral oxygen delivery and consumption? Anesth Analg 95: 1042–1048PubMedGoogle Scholar
  8. 8.
    Doppenberg EM, Zauner A, Bullock R, Ward JD, Fatouros PP, Young HF (1998) Correlations between brain tissue oxygen tension, carbon dioxide tension, pH, and cerebral blood flow — a better way of monitoring the severely injured brain? Surg Neurol 49: 650–654PubMedCrossRefGoogle Scholar
  9. 9.
    Hemphill JC 3rd, Smith WS, Sonne DC, Morabito D, Manley GT (2005) Relationship between brain tissue oxygen tension and CT perfusion: feasibility and initial results. AJNR Am J Neuroradiol 26: 1095–1100PubMedGoogle Scholar
  10. 10.
    Johnston AJ, Steiner LA, Coles JP, et al (2005) Effect of cerebral perfusion pressure augmentation on regional oxygenation and metabolism after head injury. Crit Care Med 33: 189–195PubMedCrossRefGoogle Scholar
  11. 11.
    Nortje J, Coles JP, Timofeev I, et al (2008) Effect of hyperoxia on regional oxygenation and metabolism after severe traumatic brain injury: preliminary findings. Crit Care Med 36: 273–281PubMedCrossRefGoogle Scholar
  12. 12.
    Oddo M, Nduom E, Frangos S, et al (2010) Acute lung injury is an independent risk factor for brain hypoxia after severe traumatic brain injury. Neurosurgery 67: 338–344PubMedCrossRefGoogle Scholar
  13. 13.
    Chang JJ, Youn TS, Benson D, et al (2009) Physiologic and functional outcome correlates of brain tissue hypoxia in traumatic brain injury. Crit Care Med 37: 283–290PubMedCrossRefGoogle Scholar
  14. 14.
    Oddo M, Levine JM, Mackenzie L, et al (2011) Brain hypoxia is associated with short-term outcome after severe traumatic brain injury independent of intracranial hypertension and low cerebral perfusion pressure. Neurosurgery 69: 1037–1045PubMedGoogle Scholar
  15. 15.
    Bratton SL, Chestnut RM, Ghajar J, et al (2007) Guidelines for the management of severe traumatic brain injury. X. Brain oxygen monitoring and thresholds. J Neurotrauma 24 (Suppl 1): S65–70Google Scholar
  16. 16.
    Diringer MN, Bleck TP, Claude Hemphill J 3rd, et al (2011) Critical care management of patients following aneurysmal subarachnoid hemorrhage: Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference. Neurocrit Care 15: 211–240PubMedCrossRefGoogle Scholar
  17. 17.
    Jaeger M, Schuhmann MU, Soehle M, Nagel C, Meixensberger J (2007) Continuous monitoring of cerebrovascular autoregulation after subarachnoid hemorrhage by brain tissue oxygen pressure reactivity and its relation to delayed cerebral infarction. Stroke 38: 981–986PubMedCrossRefGoogle Scholar
  18. 18.
    Muench E, Horn P, Bauhuf C, et al (2007) Effects of hypervolemia and hypertension on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation after subarachnoid hemorrhage. Crit Care Med 35: 1844–1851PubMedCrossRefGoogle Scholar
  19. 19.
    Ramakrishna R, Stiefel M, Udoetuk J, et al (2008) Brain oxygen tension and outcome in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 109: 1075–1082PubMedCrossRefGoogle Scholar
  20. 20.
    Kett-White R, Hutchinson PJ, Al-Rawi PG, Gupta AK, Pickard JD, Kirkpatrick PJ (2002) Adverse cerebral events detected after subarachnoid hemorrhage using brain oxygen and microdialysis probes. Neurosurgery 50: 1213–1221PubMedGoogle Scholar
  21. 21.
    Meixensberger J, Vath A, Jaeger M, Kunze E, Dings J, Roosen K (2003) Monitoring of brain tissue oxygenation following severe subarachnoid hemorrhage. Neurol Res 25: 445–450PubMedCrossRefGoogle Scholar
  22. 22.
    Jaeger M, Schuhmann MU, Soehle M, Meixensberger J (2006) Continuous assessment of cerebrovascular autoregulation after traumatic brain injury using brain tissue oxygen pressure reactivity. Crit Care Med 34: 1783–1788PubMedCrossRefGoogle Scholar
  23. 23.
    Jaeger M, Dengl M, Meixensberger J, Schuhmann MU (2010) Effects of cerebrovascular pressure reactivity-guided optimization of cerebral perfusion pressure on brain tissue oxygenation after traumatic brain injury. Crit Care Med 38: 1343–1347PubMedGoogle Scholar
  24. 24.
    Strege RJ, Lang EW, Stark AM, et al (2003) Cerebral edema leading to decompressive craniectomy: an assessment of the preceding clinical and neuromonitoring trends. Neurol Res 25: 510–515PubMedCrossRefGoogle Scholar
  25. 25.
    Oddo M, Levine JM, Frangos S, et al (2009) Effect of mannitol and hypertonic saline on cerebral oxygenation in patients with severe traumatic brain injury and refractory intracranial hypertension. J Neurol Neurosurg Psychiatry 80: 916–920PubMedCrossRefGoogle Scholar
  26. 26.
    Al-Rawi PG, Tseng MY, Richards HK, et al (2010) Hypertonic saline in patients with poor-grade subarachnoid hemorrhage improves cerebral blood flow, brain tissue oxygen, and pH. Stroke 41: 122–128PubMedCrossRefGoogle Scholar
  27. 27.
    Rangel-Castilla L, Lara LR, Gopinath S, Swank PR, Valadka A, Robertson C (2010) Cerebral hemodynamic effects of acute hyperoxia and hyperventilation after severe traumatic brain injury. J Neurotrauma 27: 1853–1863PubMedCrossRefGoogle Scholar
  28. 28.
    Leal-Noval SR, Rincon-Ferrari MD, Marin-Niebla A, et al (2006) Transfusion of erythrocyte concentrates produces a variable increment on cerebral oxygenation in patients with severe traumatic brain injury: a preliminary study. Intensive Care Med 32: 1733–1740PubMedCrossRefGoogle Scholar
  29. 29.
    Smith MJ, Stiefel MF, Magge S, et al (2005) Packed red blood cell transfusion increases local cerebral oxygenation. Crit Care Med 33: 1104–1108PubMedCrossRefGoogle Scholar
  30. 30.
    Martini RP, Deem S, Yanez ND, et al (2009) Management guided by brain tissue oxygen monitoring and outcome following severe traumatic brain injury. J Neurosurg 111: 644–649PubMedCrossRefGoogle Scholar
  31. 31.
    Bohman LE, Heuer GG, Macyszyn L, et al (2011) Medical management of compromised brain oxygen in patients with severe traumatic brain injury. Neurocrit Care 14: 361–369PubMedCrossRefGoogle Scholar
  32. 32.
    Stiefel MF, Spiotta A, Gracias VH, et al (2005) Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg 103: 805–811PubMedCrossRefGoogle Scholar
  33. 33.
    Meixensberger J, Jaeger M, Vath A, Dings J, Kunze E, Roosen K (2003) Brain tissue oxygen guided treatment supplementing ICP/CPP therapy after traumatic brain injury. J Neurol Neurosurg Psychiatry 74: 760–764PubMedCrossRefGoogle Scholar
  34. 34.
    McCarthy MC, Moncrief H, Sands JM, et al (2009) Neurologic outcomes with cerebral oxygen monitoring in traumatic brain injury. Surgery 146: 585–590PubMedCrossRefGoogle Scholar
  35. 35.
    Narotam PK, Morrison JF, Nathoo N (2009) Brain tissue oxygen monitoring in traumatic brain injury and major trauma: outcome analysis of a brain tissue oxygen-directed therapy. J Neurosurg 111: 672–682PubMedCrossRefGoogle Scholar
  36. 36.
    Spiotta AM, Stiefel MF, Gracias VH, et al (2010) Brain tissue oxygen-directed management and outcome in patients with severe traumatic brain injury. J Neurosurg 113: 571–580PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • P. Geukens
  • M. Oddo

There are no affiliations available

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