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Neuromonitoring in the intensive care unit. Part II. Cerebral oxygenation monitoring and microdialysis

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Abstract

Background: Monitoring the injured brain is an integral part of the management of severely brain injured patients in intensive care. There is increasing interest in methods to monitor global and regional cerebral oxygenation. There have been significant advances in analysing tissue oxygenation and local metabolites in the injured brain over the past decade. Discussion: Cerebral oxygenation can be assessed on a global or regional basis by jugular venous oximetry and near infra-red spectroscopy respectively. Techniques of brain tissue oxygenation monitoring and microdialysis are also covered in this review. Conclusions: Various modalities are available to monitor oxygenation and the local milieu in the injured brain in the intensive care unit. Use of these modalities helps to optimise brain oxygen delivery and metabolism in patients with acute brain injury.

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References

  1. Stocchetti N, Paparella A, Bridelli F, Bacchi M, Piazza P, Zuccoli P (1994) Cerebral venous oxygenation studied with bilateral samples in the internal jugular veins. Neurosurgery 34:38–44

    Article  PubMed  CAS  Google Scholar 

  2. Metz C, Holzschuh M, Bein T, Woertgen C, Rothoerl R, Kallenbach B, Taeger K, Brawanski A (1998) Monitoring of cerebral oxygen metabolism in the jugular bulb: reliability of unilateral measurements in severe head injury. J Cereb Blood Flow Metab 18:332–343

    Article  PubMed  CAS  Google Scholar 

  3. Obrist WD, Langfitt TW, Jaggi JL, Cruz J, Gennarelli TA (1984) Cerebral blood flow and metabolism in comatose patients with acute head injury: relationship to intracranial hypertension. J Neurosurg 61:245–253

    Google Scholar 

  4. Robertson CS, Narayan RK, Gokaslan Z, Pahwa R, Grossman RG, Caram P Jr, Allen E (1989) Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg 70:222–230

    Article  PubMed  CAS  Google Scholar 

  5. Robertson CS, Gopinath SP, Goodman JC, Contant CF, Valadka AB, Narayan RK (1995) SjvO2 monitoring in head-injured patients. J Neurotrauma 12:891–896

    Article  PubMed  CAS  Google Scholar 

  6. Coles JP, Minhas PS, Fryer TD, Smielewski P, Aigbirihio F, Donovan T, Downey SP, Williams G, Chatfield D, Matthews JC, Gupta AK, Carpenter TA, Clark JC, Pickard JD, Menon DK (2002) Effect of hyperventilation on cerebral blood flow in traumatic head injury: clinical relevance and monitoring correlates. Crit Care Med 30:1950–1959

    Article  PubMed  CAS  Google Scholar 

  7. Diaz-Reganon G, Minambres E, Holanda M, Gonzalez-Herrera S, Lopez-Espadas F, Garrido-Diaz C (2002) Usefulness of venous oxygen saturation in the jugular bulb for the diagnosis of brain death: report of 118 patients. Intensive Care Med 28:1724–1728

    Article  PubMed  Google Scholar 

  8. Fandino J, Kaku Y, Schuknecht B, Valavanis A, Yonekawa Y (1998) Improvement of cerebral oxygenation patterns and metabolic validation of super-selective intraarterial infusion of papaverine for the treatment of cerebral vasospasm. J Neurosurg 89:93–100

    Article  PubMed  CAS  Google Scholar 

  9. Cruz J (1996) Adverse effects of pentobarbital on cerebral venous oxygenation of comatose patients with acute traumatic brain swelling: relationship to outcome. J Neurosurg 85:758–761

    Article  PubMed  CAS  Google Scholar 

  10. Sheinberg M, Kanter MJ, Robertson CS, Constant CF, Narayan RK, Grossman RG (1992) Continuous monitoring of jugular venous oxygen saturation in head injured patients. J Neurosurg 76:212–217

    Article  PubMed  CAS  Google Scholar 

  11. Gupta AK, Hutchinson PJ, Al-Rawi P, Gupta S, Swart M, Kirkpatrick PJ, Menon DK, Datta AK (1999) Measuring brain tissue oxygenation compared with jugular venous oxygen saturation for monitoring cerebral oxygenation after traumatic brain injury. Anesth Analg 88:549–553

    PubMed  CAS  Google Scholar 

  12. Kirkpatrick PJ, Smielewski P, Czosnyka M, Menon DK, Pickard JD (1995) Near infrared spectroscopy use in patients with head injury. J Neurosurg 83:963–970

    Article  PubMed  CAS  Google Scholar 

  13. Kirkpatrick PJ, Smielewski P, Whitfield P, Czosnyka M, Menon D, Pickard JD (1995) An observational study of near infrared spectroscopy during carotid endarterectomy. J Neurosurg 82:756–763

    Article  PubMed  CAS  Google Scholar 

  14. Vernieri F, Tibuzzi F, Pasqualetti P, Rosato N, Passarelli F, Rossini PM, Silvestrini M (2004) Transcranial Doppler and near-infrared spectroscopy can evaluate the hemodynamic effect of carotid artery occlusion. Stroke 35:64–70

    Article  PubMed  Google Scholar 

  15. Al-Rawi PG, Smielewski P, Kirkpatrick PJ (2001) Evaluation of a Near-Infrared Spectrometer (NIRS 300) for the detection of intracranial oxygenation changes in the adult head. Stroke 32:2492–2500

    Article  PubMed  CAS  Google Scholar 

  16. Dunham CM, Sosnowski C, Porter JM, Siegal J, Kohli C (2002) Correlation of noninvasive cerebral oximetry with cerebral perfusion in the severe head injured patient: a pilot study. J Trauma 52:40–46

    Article  PubMed  Google Scholar 

  17. McLeod AD, Igielman F, Elwell C, Cope M, Smith M (2003) Measuring cerebral oxygenation during normobaric hyperoxia: a comparison of tissue microprobes, nearinfrared spectroscopy, and jugular venous oximetry in head injury. Anesth Analg 97:851–856

    Article  PubMed  Google Scholar 

  18. Gopinath SP, Robertson CS, Constant CF, Narayan RK, Grossman RG, Chance B (1995) Early detection of delayed intracranial haematomas using near-infrared spectroscopy. J Neurosurg 83:438–444

    Article  PubMed  CAS  Google Scholar 

  19. Villringer A, Steinbrink J, Obrig H (2004) Cerebral near-infrared spectroscopy: how far away from a routine diagnostic tool? Stroke 35:70–72

    Article  PubMed  Google Scholar 

  20. Maas AIR, Fleckenstein W, Dejong DA, Van Santbrink H (1993) Monitoring cerebral oxygenation: experimental studies and preliminary clinical results of continuous monitoring of cerebral spinal fluid and brain tissue oxygen tension. Acta Neurochir Suppl (Wien) 59:50–57

    CAS  Google Scholar 

  21. Zauner A, Bullock R, Di X, Young HF (1995) Brain oxygen, CO2, pH, and temperature monitoring: evaluation in the feline brain. J Neurosurg 37:1168–1177

    Article  CAS  Google Scholar 

  22. Keining KL, Unterberg AW, Bardt TF, Schneider GH, Lanksch WR (1996) Monitoring cerebral oxygenation in patients with head injuries: brain tissue PO2 versus jugular vein saturation. J Neurosurg 85:751–757

    Article  Google Scholar 

  23. 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 50:1213–1221

    PubMed  Google Scholar 

  24. Charbel FT, Du X, Hoffman WE, Ausman JI (2002) Brain tissue PO2, PCO2, and pH during cerebral vasospasm. J Neurosurg 97:1302–1305

    Article  Google Scholar 

  25. Gupta AK, Zygun D, Johnston AJ, Steiner LA, Al-Rawi PG, Chatfield D, Shepherd E, Kirkpatrick PJ, Hutchinson PJ, Menon DK (2004) Extracellular brain pH and outcome following severe traumatic brain injury. J Neurotrauma 21:678–684

    Article  PubMed  Google Scholar 

  26. Gupta AK, Hutchinson PJ, Al-Rawi P, Gupta S, Swart M, Kirkpatrick PJ, Menon DK, Datta AK (1999) Measurement of brain tissue oxygenation compared with jugular venous oxygen saturation for monitoring cerebral oxygenation after traumatic brain injury. Anesth Analg 88:549–553

    PubMed  CAS  Google Scholar 

  27. Gupta AK, Hutchinson PJ, Fryer T, Al-Rawi PG, Parry DA, Minhas PS, Kett-White R, Kirkpatrick PJ, Mathews JC, Downey S, Aigbirhio F, Clark J, Pickard JD, Menon DK (2002) Measurement of brain tissue oxygenation performed using positron emission tomography scanning to validate a novel monitoring method. J Neurosurg 96:263–268

    Article  PubMed  Google Scholar 

  28. Menon DK, Coles JP, Gupta AK, Fryer TD, Smielewski P, Chatfield DA, Aigbirhio F, Skepper JN, Minhas PS, Hutchinson PJ, Carpenter TA, Clark JC, Pickard JD (2004) Diffusion limited oxygen delivery following head injury. Crit Care Med 32:1384–1390

    Article  PubMed  Google Scholar 

  29. Hutchinson PJ, O’Connell MT, Al- Rawi PG, Maskell LB, Kett-White R, Gupta AK, Richards HK, Hutchinson DB, Kirkpatrick PJ, Pickard JD (2000) Clinical cerebral microdialysis: a methodological study. J Neurosurg 93:37–43

    Article  PubMed  CAS  Google Scholar 

  30. Whittle IR, Glasby M, Lammie A, Bell H, Ungerstedt U (1998) Neuropathological findings after intracerebral implantation of microdialysis catheters. Neuroreport 9:2821–2825

    Article  PubMed  CAS  Google Scholar 

  31. Sarrafzadeh AS, Sakowitz OW Keining KL, Benndorf G, Lanksch WR, Unterbrg AW (2002) Bedside microdialysis: a tool to monitor cerebral metabolism in subarachnoid hemorrhage patients? Crit Care Med 30:1062–1070

    Article  PubMed  Google Scholar 

  32. Stahl N, Schalen W, Ungerstedt U, Nordstrom CH (2003) Bedside biochemical monitoring of the penumbra zone surrounding an evacuated acute subdural haematoma. Acta Neurol Scand 108:211–215

    Article  PubMed  CAS  Google Scholar 

  33. Bellander B-M, Cantais E, Enblad P, Hutchinson P, Nordstrom C-H, Robertson CS, Sahuquillo J, Smith M, Stocchetti N, Ungerstedt U, Unterberg A, Vidiendal Olsen NV (2004) Consensus meeting on microdialysis in neurointensive care. Intensive Care Med 30: 2166–2169

    Article  PubMed  Google Scholar 

  34. Johnston AJ, Gupta AK (2002) Advanced monitoring in the neurology intensive care unit: microdialysis. Curr Opin Crit Care 8:121–127

    Article  PubMed  Google Scholar 

  35. Persson L, Valtysson J, Enblad P, Warme PE, Cesarini K, Lewen A, Hillered L (1996) Neurochemical monitoring using intracerebral microdialysis in patients with subarachnoid hemorrhage. J Neurosurg 84:606–616

    Article  PubMed  CAS  Google Scholar 

  36. Peerdeman SM, Girbes AR and Vandertop WP (2000) Cerebral microdialysis as a new tool for neurometabolic monitoring. Intensive Care Med 26:662–669

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anaesthesia, Addenbrooke’s Hospital, Cambridge, UK

    Anuj Bhatia & Arun Kumar Gupta

  2. Neuroscience Critical Care Unit, Addenbrooke’s Hospital, Cambridge, UK

    Arun Kumar Gupta

Authors
  1. Anuj Bhatia
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  2. Arun Kumar Gupta
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Editor information

Editors and Affiliations

  1. Medical Center, Div. Critical Care Medicine, University of Pittsburgh, Terrace Street 3550, Pittsburgh, 15261, Pennsylvania, USA

    Michael R. Pinsky

  2. Dept. Intensive Care Medicine, Hopital Henri Mondor, av.Maréchal Lattre de Tassigny 51, Créteil CX, 94010, France

    Laurent Brochard

  3. Dept. Clinical Physiology, Uppsala University Hospital, Uppsala, 751 85, Sweden

    Göran Hedenstierna

  4. , General Intensive Care Unit, Università Cattolica des Sacro Cuore, Largo A. Gemelli 8, Rome, 00168, Italy

    Massimo Antonelli

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© 2012 Springer-Verlag Berlin Heidelberg

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Bhatia, A., Gupta, A.K. (2012). Neuromonitoring in the intensive care unit. Part II. Cerebral oxygenation monitoring and microdialysis. In: Pinsky, M., Brochard, L., Hedenstierna, G., Antonelli, M. (eds) Applied Physiology in Intensive Care Medicine 1. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-28270-6_31

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  • DOI: https://doi.org/10.1007/978-3-642-28270-6_31

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-28269-0

  • Online ISBN: 978-3-642-28270-6

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