Monitoring PtiO₂ and Changes in Oxygen Fraction in the Breathed Mixture after Severe Subarachnoid Haemorrhage

Czech version

Authors: M. Smrčka; E. Neuman; K. Ďuriš; T. Svoboda; M. Duba
Authors‘ workplace: Neurochirurgická klinika LF MU a FN Brno
Published in: Cesk Slov Neurol N 2010; 73/106(6): 694-700
Category: Original Paper

Overview

Introduction:
The aim of this study was to evaluate any possible improvement in outcome for post-severe-SAH patients that might result from monitoring tissue oxygen in the brain (PtiO₂, Licox system) and manipulation of the fraction of oxygen in the inhaled mixture of gases (FiO₂) with respect to PtiO₂ value. Material and methods: 45 patients with aneurysm SAH HH 3, 4 and 5 were enrolled in the study (2007–2009). All patients were artificially ventilated. The first group consisted of 22 patients with SAH HH 4 and 5 treated by coiling. The second group consisted of 23 patients with SAH HH 3 and 4 treated by clipping. The groups were randomly divided into experimental and control subgroups. In the experimental subgroups, PtiO₂ was monitored. If the PtiO₂ value dropped below 15 mmHg and had not improved after 30 minutes, FiO₂ was increased from the default values (range 40–55%) to higher levels (range 70–85%). If the PtiO₂ level reached 15 mmHg for at least an hour, FiO₂ was brought back to a lower level. Treatment outcome was quantified using the Glasgow Outcome Scale (GOS) and evaluated 3 months after the SAH. Results: The treatment results for patients with and without the use of PtiO₂ monitoring did not differ statistically. Conclusion: Therapy with FiO₂ manipulation subsequent to PtiO₂ measurements did not improve the outcome in patients suffering from SAH, HH 3, 4 and 5. It appears likely that vasospasm prevents PtiO₂ increase in response to FiO₂ elevation.

Keywords:
brain tissue oxygen – subarachnoid haemorrhage – vasospasm

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