Brain Tissue Oxygen Monitoring
Authors:
M. Filaun 1; M. Horáček 1; J. Steindler 2; L. Pekař 2; K. Cvachovec 1
Authors‘ workplace:
Klinika anesteziologie a resuscitace 2. LF UK a IPVZ, FN v Motole, Praha
1; Oddělení neurochirurgie, FN v Motole, Praha
2
Published in:
Cesk Slov Neurol N 2008; 71/104(6): 657-663
Category:
Review Article
Overview
This review refers to brain tissue oxygen monitoring as part of multimodal monitoring completing current monitoring of intracranial pressure and jugular oxymetry. Brain tissue oxygen monitoring brings additional data about the condition of the brain. The pathophysiology of the brain injury, the mechanisms of origin of secondary brain injury including disorders of oxygenation and common principles of treatment and prevention of secondary brain injury are explained in the article. Differences between global and local monitoring of oxygenation are described. The clinical part describes the application and placement of the sensor into the brain tissue and the options for specific therapeutic intervention. Also the technical principles of the monitoring system, of the determination of the normal and pathologic values of brain tissue oxygen and the interpretation of the measured oxygen values are explained. Brain tissue oxygen monitoring can be useful in the treatment of brain trauma, in spontaneous subarachnoid haemorrhage and in brain aneurysma surgery.
Key words:
brain tissue oxygenation – multimodal monitoring – traumatic brain injury – secondary brain injury
Sources
1. Cerebrum 2007 o.s. (Sdružení osob po poranění mozku a jejich rodin). Statistika [online]. Dostupné z URL: http:/ / www.cerebrum2007.cz/ poraneni- mozku- statistika.php.
2. Scho uten JW. Ochrana mozku při jeho poranění – složitý boj s přírodo u. Curr Opin Crit Care/ CZ 2007; 1: 26– 34.
3. Cremer OL. Does ICP monitoring make a difference in ne urosurgical care? Eur J Anaesthesi ol 2008; 25 (Suppl 42): 87– 93.
4. Jones PA, Andrews PJ, Midgley S, Anderson SI, Piper IR, Tocher JL et al. Me asuring the burden of secondary insults in he ad- injured pati ents during intensive care. J Ne urosurg Anesthesi ol 1994; 6(1): 4– 14.
5. Mazze o AT, Bullock R. Monitoring brain tissue oxymetry: will it change management of critically ill ne urologic pati ents? J Ne urol Sci 2007; 261(1– 2): 1– 9.
6. Chesnut RM. Secondary brain insults after he ad injury: clinical perspectives. New Horiz 1995; 3(3): 366– 375.
7. Cho i DW. Ionic dependence of glutamate ne urotoxicity. J Ne urosci 1987; 7(2): 369– 379.
8. Crompton M. The mitochondri al perme ability transiti on pore and its role in cell de ath. Bi ochem J 1999; 341(2): 233– 249.
9. Unterberg AW, Stover JF, Kress B, Ki ening KL. Edema and brain tra uma. Ne urosci ence 2004; 129(4): 1021– 1029.
10. Gupta AK. Applicati on of multimodal monitoring. In: Gupta AK, Summors A(eds). Notes in Ne uro anaesthesi a and Critical Care. London: Greenwich Medical Medi a 2001: 260– 262.
11. Fakhry SM, Trask AL, Waller MA, Watts DD. Management of brain‑injured pati ents by an evidence‑based medicine protocol improves o utcomes and decre ases hospital charges. J Tra uma 2004; 56(3): 492– 499.
12. Patel HC, Menon DK, Tebbs S, Hawker R, Hutchinson PJ, Kirkpatrick PJ. Speci alist ne urocritical care and o utcome from he ad injury. Intensive Care Med 2002; 28(5): 547– 553.
13. Reilly PL. Brain injury: the pathophysi ology of the first ho urs. “Talk and di e revisited”. J Clin Ne urosci 2001; 8(5): 398– 403.
14. Rosenthal G, Hemphill JC jr, Sorani M,Martin C, Morabito D, Obrist WD et al. Brain tissue oxygen tensi on is more indicative of oxygen diffusi on than oxygen delivery and metabolism in pati ents with tra umatic brain injury. Crit Care Med 2008; 36(6): 1917– 1924.
15. Ferda J, Kastner J, Kre uzberg B, Novák M, Rohan V. Zobrazení akutní mozkové ischémi e. Ces Radi ol 2007; 31(3): 231– 241.
16. Artru F, Jo urdan C, Perret- La udet A, Charlot M, Mottolese C. Low brain tissue oxygen pressure: incidence and corrective therapi es. Ne urol Res 1998; 20 (Suppl 1): S48– S61.
17. Härtl R, Bardt TF, Ki ening KI, Sarrafzadeh AS, Schneider GH, Unterberg AW. Mannitol decre ases ICP but does not improve brain‑tissue pO2 in severely he ad- injured pati ents with intracrani al hypertensi on. Acta Ne urochir 1997; 70 (Suppl): 40– 42.
18. Ki ening KL, Unterberg AW, Bardt TF, Schneider GH, Lanksch WR. Monitoring of cerebral oxygenati on in pati ents with severe he ad injuri es: brain tissue pO2, versus jugular vein saturati on. J Ne urosurg 1996; 85(5): 751– 757.
19. van Santbrink H, Maas AI, Avezaat CJ. Continuo us monitoring of parti al pressure of brain tissue oxygen, in pati ents with severe he ad injury. Ne urosurgery 1996; 38(1): 21– 31.
20. al- Rawi PG, Hutchinson PJ, Gupta AK, Pi echnik SK, Pickard JD, Kirkpatrick PJ. Multiparameter brain tissue monitoring– correlati on between parameters and identificati on of CPP thresholds. Zentralbl Ne urochir 2000; 61(2): 74– 79.
21. Kett- White R, Hutchinson PJ, Czosnyka M, al- Rawi P, Gupta A, Kirkpatrick PJ et al. Effects of vari ati on in cerebral haemodynamics during ane urysm surgery on brain tissue oxygen and metabolism. Acta Ne urochir 2002; 81 (Suppl): 327– 329.
22. Gupta AK, Hutchinson PJ, Fryer T, Al- Rawi PG, Parry DA, Minhas PS et al. Me asurement of brain tissue oxygenati on performed using positron emissi on tomography scanning to validate a novel monitoring method. J Ne urosurg 2002; 96(2): 263– 268.
23. Za uner A, Doppenberg E, Wo odward JJ, Cho i S, Yo ung HF, Bullock R. Continuo us monitoring of cerebral substrate delivery and cle arance: Initi al experi ence in 24 pati ents with severe acute brain injury. Ne urosurgery 1997; 41(5): 1082– 1093.
24. Menzel M, Doppenberg EM, Za uner A,So ukup J, Reinert MM, Cla usen T et al. Cerebral oxygenati on in pati ents after severe he ad injury: monitoring and effects of arteri al hyperoxi a on cerebral blo od flow, metabolism and intracrani al pressure. J Ne urosurg Anesthesi ol 1999; 11(4): 240– 251.
25. Dings J, Meixensberger J, Jäger A, Ro osen K. Clinical experi ence with 118 brain tissue oxygen parti al pressure catheter probes. Ne urosurgery 1998; 43(5): 1082– 1095.
26. Hoelper BM, Alessandri B, Heimann A, Behr R, Kempski O. Brain oxygen monitoring: in‑vitro accuracy, long‑term drift and response- time of Licox- and Ne urotrend sensors. Acta Ne urochir (Wi en) 2005; 147(7): 767– 774.
27. Jaeger M, Soehle M, Meixensberger J. Brain tissue oxygen (PtiO2): a clinical comparison of two monitoring devices. Acta Ne urochir 2005; 95 (Suppl): 79– 81.
28. Wilensky EM, Blo om S. Monitoring brain tissue oxygenati on after severe brain injury. Nursing 2005; 35(2): 32cc1– 32cc4.
29. Maas AL, Fleckenstein W, de Jong DA, van Santbrink H. Monitoring cerebral oxygenati on: Experimental studi es and preliminary clinical results of continuo us monitoring of cerebrospinal fluid and brain tissue oxygen tensi on. Acta Ne urochir (Wi en) 1993; 59 (Suppl): 50– 57.
30. Meixensberger J, Dings J, Kuhnigk H, Ro osen K. Studi es of tissue pO2 in normal and pathological human brain cortex. Acta Ne urochir (Wi en) 1993; 59 (Suppl): 58– 63.
31. Za uner A, Bullock R, Di X, Yo ung HF. Brain oxygen, CO2, pH, and temperature monitoring: evalu ati on in feline brain. Ne urosurgery 1995; 37(6): 1168– 1177.
32. Hoffman WE, Charbel FT, Edelman G, Hannigan K, Ausman JI. Brain tissue oxygen pressure, carbon di oxide pressure and pH during ischemi a. Ne urol Res 1996; 18(1): 54– 56.
33. Za uner A, Doppenberg E, Wo odward J, Allen C, Jebraili S, Yo ung HF et al. Multiparametric continuo us monitoring of brain metabolism and substrate delivery in ne urosurgical pati ents. Ne urol Res 1997; 19(3): 265– 273.
34. Za uner A, Doppenberg EM, So ukup J, Menzel M, Yo ung HF, Bullock R. Extended ne uromonitoring: new therape utic opportuniti es? Ne urol Res 1998; 20 (Suppl 1): S85– S90.
35. Watson JC, Doppenberg EM, Bullock R,Za uner A, Yo ung HF. Effect of allosteric hemoglobin modifi er RSR 13 upon oxygen transportati on in ischemic brain, and upon infarct size in a feline model of human stroke. Stroke 1998; 28: 1624– 1630.
36. Doppenberg EM, Za uner A, Bullock R,Ward JD, Marmaro u A, Fato uros P et al. Correlati on between pO2 , pCO2, pH and cerebral blo od flow – a better way of monitoring the severly injured brain? Surg ne urol 1998; 49: 650– 654.
37. Doppenberg EM, Za uner A, Watson JC, Bullock R. Determinati on of the ischemic threshold for oxygen tensi on. Acta Ne urochir 1998; 71 (Suppl): 166– 169.
38. Heiss WD, Hayakawa T, Waltz AG. Cortical ne uronal functi on during ischemi a. Effects of occlusi on of one midle cerebral artery on single‑unit activity in cats. Arch Ne urol 1976; 33: 813– 820.
39. Jones TH, Morawetz RB, Crowell RM, Marco ux FW, FitzGibbon SJ, DeGirolami Uet al. Thresholds of focal ischemi a in awake monkeys. J Ne urosurg 1981; 54(6): 773– 782.
40. Morawetz RB, DeGirolami U, Ojemann RG, Marco ux FW, Crowell RM. Cerebral blo od flow determined by hydrogen cle arance during middle cerebral artery occlusi on in anesthetized monkeys. Stroke 1978; 9(2): 143– 149.
41. Sharbro ugh FW, Messick JM jr, Sundt TM jr. Correlati on of continuo us electroencephalograms with cerebral blo od flow me asurements during carotid endarterectomy. Stroke 1973; 4(4): 674– 683.
42. Robertson CS. Desaturati on episodes after severe he ad injury: influence on o utcome. Acta Ne urochir (Wi en) 1993; 59 (Suppl): 98– 101.
43. Sheinberg M, Kanter MJ, Robertson CS, Contant CF, Narayan RK, Crossman RG. Continuo us monitoring of jugular vein saturati on in he ad injured pati ents. J Ne urosurg 1992; 76(2): 212– 217.
44. Valadka AB, Gopinatu SP, Contact CF, Uzura M, Robertson CS. Relati onship of brain tissue pO2 to o utcome after severe he ad injury. Crit Care Med 1998; 26(9): 1576– 1581.
45. van den Brink WA, van Sabrink H, Steyerberg EW, Avezaat CJJ, Su azo JA, Hogesteeger C et al. Brain oxygen tensi on in severe he ad injury. Ne urosurgery 2000; 46(4): 868– 876.
46. Bardt TF, Unterberg AW, Härtl R, Ki ening KL, Schneider GH, Lanksch WR. Monitoring of brain tissue PO2 in tra umatic brain injury: effect of cerebral hypoxi a on o utcome. Acta Ne urochir 1998; 71 (Suppll): 153– 156.
47. Nortje J, Gupta AK. The role of tissue oxygen monitoring in pati ents with acute brain injury. Br J Anaesth 2006; 97(1): 95– 106.
48. Andrews PJ, Citeri o G, Longhi L, Polderman K, Sahuquillo J, Vajkoczy P. Ne uro‑Intensive Care and Emergency Medicine (NICEM) Secti on of the Europe an Soci ety of Intensive Care Medicine. NICEM consensus on ne urological monitoring in acute ne urological dise ase. Intensive Care Med 2008; 34(8): 1362– 1370.
49. Brain Tra uma Fo undati on, American Associ ati on of Ne urological Surge ons, Congress of Ne urological Surge ons, Jo int Secti on on Ne urotra uma and Critical Care, AANS/ CNS. Guidelines for the management of severe tra umatic brain injury. X. Brain oxygen monitoring and thresholds. J Ne urotra uma 2007; 24 (Suppl 1): S65– S70.
50. Pachl J, Haninec P, Tencer T, Mizner P, Ho usťava L, Tomas R et al. The effect of subarachno id sodi um nitroprusside on the preventi on of vasospasm in subarachno id haemorrhage. Acta Ne urochir 2005; 95 (Suppl): 141– 145.
51. Gál R, Smrčka M, Što urač P, Straževská E, Ne umann E. Měření tkáňového kyslíku v mozku jako so učást multimodálního monitorování: kazuistiky. Cesk Slov Ne urol N 2007; 70/ 103(5): 562– 566.
52. Hejčl A, Bartoš R, Humhej I, Bolcha M, Bejšovec D, Procházka J et al. Dekompresivní krani ektomi e v léčbě posttra umatického edému mozku a přínos nových monitorovacích metod. Čas Lék čes 2007; 146(4): 307– 312.
Labels
Paediatric neurology Neurosurgery NeurologyArticle was published in
Czech and Slovak Neurology and Neurosurgery
2008 Issue 6
Most read in this issue
- Multiple Sclerosis and Magnetic Resonance Imaging: Present Status and New Trends
- Adult Age Sleep Apnoea
- Subacute Hypertensive Reversible Leukoencephalopathy – a Case Report
- Protein 14-3-3 Detection in Cerebrospinal Fluid – Clinico-Pathological Correlation