Brain Tissue Oxygen Monitoring to Assess Reperfusion after Intra-Arterial Treatment of Aneurysmal Subarachnoid Hemorrhage−Induced Cerebral Vasospasm: A Retrospective Study

Deshaies, Eric M.; Jacobsen, Wayne K.; Singla, Amit; Li, F.; Gorji, Reza

doi:10.3174/ajnr.a2971

Cited by 17 publications

(9 citation statements)

References 18 publications

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“…There is a well-described relationship between hyperventilation, reduced PaCO 2 , and decreased PbtO 2 as well as between impaired lung function and low PbtO 2 : recruitment maneuvers (PEEP of 30-40 cmH2O) may thus help improve PbtO 2 [107] but this effect may depend on hemodynamic stability [108]. Finally PbtO 2 monitor use and changes in ORx are described in SAH induced vasospasm management [27,74,[109][110][111][112][113][114][115][116][117] both to provide insight about an intervention or to ''predict'' delayed cerebral ischemia [109,110,114].…”

Section: Does Pbto 2 Monitoring Help Guide Management?mentioning

confidence: 99%

Monitoring of Brain and Systemic Oxygenation in Neurocritical Care Patients

Oddo

Bösel

2014

Neurocrit Care

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Maintenance of adequate oxygenation is a mainstay of intensive care, however, recommendations on the safety, accuracy, and the potential clinical utility of invasive and non-invasive tools to monitor brain and systemic oxygenation in neurocritical care are lacking. A literature search was conducted for English language articles describing bedside brain and systemic oxygen monitoring in neurocritical care patients from 1980 to August 2013. Imaging techniques e.g., PET are not considered. A total of 281 studies were included, the majority described patients with traumatic brain injury (TBI). All tools for oxygen monitoring are safe. Parenchymal brain oxygen (PbtO2) monitoring is accurate to detect brain hypoxia, and it is recommended to titrate individual targets of cerebral perfusion pressure (CPP), ventilator parameters (PaCO2, PaO2), and transfusion, and to manage intracranial hypertension, in combination with ICP monitoring. SjvO2 is less accurate than PbtO2. Given limited data, NIRS is not recommended at present for adult patients who require neurocritical care. Systemic monitoring of oxygen (PaO2, SaO2, SpO2) and CO2 (PaCO2, end-tidal CO2) is recommended in patients who require neurocritical care.

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Section: Does Pbto 2 Monitoring Help Guide Management?mentioning

confidence: 99%

Monitoring of Brain and Systemic Oxygenation in Neurocritical Care Patients

Oddo

Bösel

2014

Neurocrit Care

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“…Increasing the oxygen carrying capacity by blood transfusion increases the PbtO 2 in as little as 2 h [ 85 ]. In poor grade aSAH patients that underwent intra-arterial spasmolysis, a rise in PbtO 2 after treatment correlated with the angiographic response of improved blood flow [ 86 ]. The availability of measures to affect brain tissue oxygenation reinforces the clinical utility of real-time PbtO 2 monitoring.…”

Section: Pbto 2 Monitoringmentioning

confidence: 99%

Brain Monitoring in Critically Neurologically Impaired Patients

Jones

Schwartzbauer

Jia

2016

IJMS

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Assessment of neurologic injury and the evolution of severe neurologic injury is limited in comatose or critically ill patients that lack a reliable neurologic examination. For common yet severe pathologies such as the comatose state after cardiac arrest, aneurysmal subarachnoid hemorrhage (aSAH), and severe traumatic brain injury (TBI), critical medical decisions are made on the basis of the neurologic injury. Decisions regarding active intensive care management, need for neurosurgical intervention, and withdrawal of care, depend on a reliable, high-quality assessment of the true state of neurologic injury, and have traditionally relied on limited assessments such as intracranial pressure monitoring and electroencephalogram. However, even within TBI there exists a spectrum of disease that is likely not captured by such limited monitoring and thus a more directed effort towards obtaining a more robust biophysical signature of the individual patient must be undertaken. In this review, multimodal monitoring including the most promising serum markers of neuronal injury, cerebral microdialysis, brain tissue oxygenation, and pressure reactivity index to access brain microenvironment will be discussed with their utility among specific pathologies that may help determine a more complete picture of the neurologic injury state for active intensive care management and long-term outcomes. Goal-directed therapy guided by a multi-modality approach appears to be superior to standard intracranial pressure (ICP) guided therapy and should be explored further across multiple pathologies. Future directions including the application of optogenetics to evaluate brain injury and recovery and even as an adjunct monitoring modality will also be discussed.

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“…The utility of pbtO2 monitoring in cerebral vasospasm afer SAH is subject of three reports [279][280][281]. The first study reports that post-operative TCD vasospasm developed in 13 patients, all of which had intraoperative pre-clipping pbtO2 < 10mmHg and pbtO2 was significantly lower in cases that developed TCD vasospasm.…”

Section: Vasospasm Detection After Sahmentioning

confidence: 99%

“…The second study reports a significant pbtO2 increase in a series of vasospasm patients after endovascular treatment while CPP, ICP, SaO(2), and FiO 2 , did not. They conclude that: "pbtO2 monitoring provides the interventionalist with an objective physiologic parameter to determine adequate spasmolysis" but point out that: "Further investigation is needed to establish target pbtO2 rates indicative of adequate reperfusion, which can be used in the endovascular suite" [280]. The third study reports that Erythropoietin increases pbtO2 in severe SAH patients with severe cerebral vasospasm but they point out that the effect on outcome requires further investigation [281].…”

Section: Vasospasm Detection After Sahmentioning

confidence: 99%

Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

Lang

Jaeger²

2013

TOCCMJ

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This review has been compiled to assess publications related to the clinical application of direct cerebral tissue oxygenation (pbtO2) monitoring published in international, peer-reviewed scientific journals, or major meeting reports published as journal supplements. Its goal was to extract relevant, i.e. positive and negative, information on indications, clinical application, safety issues and impact on clinical situations, as well as treatment strategies in neurosurgery, neurosurgical anaesthesiology, neurosurgical intensive care, neurology, and related specialties. For completeness' sake it also presents related basic science research and case reports. This review is an update of its previous edition published elsewhere in 2007. This review reflects publications from 2004 to 2012. Only relevant publications prior to 2004, which explicitly addressed or systematically examined the above issues, are included in this review and are listed in the reference section. Based on 349 citations it is the most comprehensive review available on direct cerebral oxygen monitoring to this date.Keywords: Review, cerebral oxygenation, raumedic, licox, neurotrend, cerebral partial pressure of oxygen, brain tissue oxygenation. METHODSThis review is based on a systematic "Medline" literature search using the following search terms: licox, neurotrend, neurovent, raumedic, brain tissue oxygen, brain tissue oxygenation, cerebral oxygenation, cerebral tissue oxygen, cerebral partial pressure of oxygen, btO2, ptiO2, pti(O)2, ptiO(2), pbrO2, PBr(O2), P(bt)O(2), P(br)O(2), PbrO(2), BTpO2, tP(O2), PbO2, PbtO2, Pbto, PbtO(2).Only few publications were not retrieved using this technique. They were, however, identified through personal communication with scientists in the field, meeting proceedings and reviewer assignments. This strategy provided sufficient certainty that relevant papers have not been missed. Unpublished meeting abstracts and published conference proceedings were excluded for this review expect for few which provided comparative studies between different probes. To address relevant matters, related to specific pbtO2 issues, selected non-peer reviewed papers published in supplements were also used only when no other peer-reviewed information was available. RESULTSThis review is based on a previous review [1]. It is currently based on 349 papers, 274 more papers compared to its previous version in 2007, which warrants the update.

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Brain Tissue Oxygen Monitoring to Assess Reperfusion after Intra-Arterial Treatment of Aneurysmal Subarachnoid Hemorrhage−Induced Cerebral Vasospasm: A Retrospective Study

Cited by 17 publications

References 18 publications

Monitoring of Brain and Systemic Oxygenation in Neurocritical Care Patients

Monitoring of Brain and Systemic Oxygenation in Neurocritical Care Patients

Brain Monitoring in Critically Neurologically Impaired Patients

Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

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