Cerebral oximetry with blood volume index and capnography in intubated and hyperventilated patients

Bagwell, Taylor; Abramo, Thomas J.; Albert, Gregory W.; Orsborn, Jonathan; Storm, Elizabeth; Hobart-Porter, Nicolas W.; Thompson, Tonya; Öcal, Eylem; Hu, Zhuopei; Nick, Todd G.

doi:10.1016/j.ajem.2016.03.005

Cited by 8 publications

(35 citation statements)

References 18 publications

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“…The study's bihemispheric r c SO 2 and CBVI reading discordance differences significantly correlated with identified radiographical cerebral pathology and were highly predictive of the cerebral pathology as in prior studies. 7,12,[15][16][17][18][19][20][25][26][27][28][29][30] Three percent % HTS infusion effects showed patients with interhemispheric discordance >10, and initial r c SO 2 and CBVI readings <60%, and left or right cerebral pathology had the most significant narrowing of interhemispheric r c SO 2 and CBVI discordance. 7,12,[15][16][17][18][19][20][25][26][27][28][29][30] Patients with epidural hematomas had no substantial change in their interhemispheric discordance, or corresponding heart rate did not change (Tables 5 and 6).…”

Section: Discussionmentioning

confidence: 99%

“…Three percent HTS hyperosmolar effect has limited benefit for increased regional perfusion due to the expanding arterial expanding hematoma. 7,12,[15][16][17][18][19][20][25][26][27][28][29][30] This epidural effect could explain the epidural hematoma patient's limited changes in r c SO 2 and CBVI readings after 3% HTS infusions.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] In the early trauma and neurological resuscitative phase, this indirect neurological monitoring methodology has demonstrated that these subtle neurological changes are often missed and not corrected promptly. [1][2][3][4][5][6][7][8][9][10][11][12] Poor outcomes for these patients have been correlated with prolonged peripheral hypoxia (assumed to reflect cerebral hypoxia), systemic hypotension (assumed to reflect cerebral hypoperfusion), or hypercarbia. [1][2][3][4][5][6][7][8][9][10][11][12] Currently, for PED-intubated patients with isolated TBI, there is no way to detect or trend trauma-related alterations in bihemispheric cerebral physiology, nor can the effectiveness of hyperosmolar therapy be effectively measured.…”

mentioning

confidence: 99%

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Assessing the Impact of 3% Hypertonic Saline Hyperosmolar Therapy on Intubated Children With Isolated Traumatic Brain Injury by Cerebral Oximetry in a Pediatric Emergency Setting

et al. 2020

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Background: Intubated pediatric patients with isolated traumatic brain injury (TBI) are a diagnostic challenge for early detection of altered cerebral physiology instigated by trauma-induced increased intracranial pressure (ICP) while preventing secondary neuronal damage (secondary insult detection) and assessing the effects of increased ICP therapeutic interventions (3% hypertonic saline [HTS]). Invasive brain tissue oxygen monitoring is guiding new intensive care unit TBI management but is not pediatric emergency department (PED) readily accessible. Objective measurements on pediatric isolated TBI-altered bihemispheric cerebral physiology and treatment effects of 3% HTS are currently lacking. Cerebral oximetry can assess increased ICP-induced abnormal bihemispheric cerebral physiology by measuring regional tissue oxygenation (r c SO 2 ) and cerebral blood volume index (CBVI) and the mechanical cerebrospinal fluid removal effects on the increased ICP-induced abnormal bihemispheric cerebral physiology.In the PED intubated patients with isolated TBI, assessing the 3% HTS therapeutic response is solely by vital signs and limited clinical assessment skills. Objective measurements of the 3% HTS hyperosmolar effects on the PED isolated TBI patients' altered bihemispheric cerebral physiology are lacking. We believe that bihemispheric r c SO 2 and CBVI could elucidate similar data on 3% HTS impact and influence in the intubated isolated TBI patients.Objective: This study aimed to analyze the effects of 3% HTS on bihemispheric r c SO 2 and CBVI in intubated patients with isolated TBI.Methods: An observational, retrospective analysis of bihemispheric r c SO 2 and CBVI readings in intubated pediatric patients with isolated TBI receiving 3% HTS infusions, was performed.Results: From 2010 to 2017, 207 intubated patients with isolated TBI received 3% HTS infusions (median age, 2.9 [1.1-6.9 years]; preintubation Glasgow Coma Scale score, 7 [6][7][8]). The results were as follows: initial pre−3% HTS, 43% (39.5% to 47.5%; left) and 38% (35% to 42%; right) for r c SO 2 < 60%, and 8 (−28 to 21; left) and −15

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Assessing the Impact of 3% Hypertonic Saline Hyperosmolar Therapy on Intubated Children With Isolated Traumatic Brain Injury by Cerebral Oximetry in a Pediatric Emergency Setting

et al. 2020

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“…Non-heart beating donation has become an important source of organs for transplantation, particularly kidneys, in the course of the last decade. 14,16 According to data from the Spanish National Transplantation Organization (Organización Nacional de Trasplantes), a total of 126 kidneys, 15 lungs and 9 livers were transplanted in the year 2016. 15 However, the conditions characterizing CPA imply increased tissue vulnerability and aggression.…”

Section: Discussionmentioning

confidence: 99%

“…The following data were collected corresponding to the donors registered by the transplantation coordinator of Doce de Octubre University Hospital: gender, age, smoking, background diseases, time of CPA, time of start of advanced life support (ALS) measures, time of patient hospital transfer, time of arterial catheterization, time of start of extracorporeal circulation, time of clamping prior to organ harvesting, transplantation or not of the kidney, and the capnography values at the start of cardiopulmonary resuscitation (CPR), half-way through the emergency services care period, and at the time of in-hospital transfer. On a consensus basis among the authors, with their experience in interpreting capnographic data, and in accordance with the literature, 16 the capnography values were classified as normal or adequate if over 30 mmHg.…”

Section: Methodsmentioning

confidence: 98%

Capnometry levels as an indicator of renal graft evolution in uncontrolled non-heart beating donors

Rodríguez

Delgado

Arias

et al. 2020

Medicina Intensiva (English Edition)

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Objective: The capnometry values during resuscitation are an evolutive predictor of kidneys obtained from uncontrolled non-heart beating donors. Design: The study comprised a retrospective onset cohort of 37 non-heart beating donors and a validation cohort of 55 transplanted kidneys in the period 2013---2017. Scope: The population served by the emergency service and referred to Hospital Universitario Doce de Octubre (Madrid, Spain) as potential uncontrolled non-heart beating donors. Patients: A total of 55 renal transplant patients subjected to hemodialysis and with grafts from uncontrolled non-heart beating donors. Interventions: Capnometry and capnography measurements in potential uncontrolled non-heart beating donors. Variables: Capnometry values recorded initially and at transfer in hospital for comparison with the viability of the extracted kidneys; renal failure and delayed renal function. Results: A total of 55 out of 74 extracted kidneys were transplanted (74.3%). The rest were ruled out due to poor perfusion or signs of ischemia. An association was observed (p = 0.016) between the capnometry values during resuscitation in the grafted kidneys ( = 22.8 mmHg) and in the kidneys discarded for transplantation ( = 17.35 mmHg). Conclusions: Capnometry during resuscitation serves as a marker to be taken into account in relation to the viability of the transplanted organs in uncontrolled non-heart beating donors.

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The Effect of Chronic Pulmonary Disease and Mechanical Ventilation on Corneal Donor Endothelial Cell Density and Transplant Suitability

Margo

Whiting

Brown

et al. 2017

American Journal of Ophthalmology

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Cerebral oximetry with blood volume index and capnography in intubated and hyperventilated patients

Cited by 8 publications

References 18 publications

Assessing the Impact of 3% Hypertonic Saline Hyperosmolar Therapy on Intubated Children With Isolated Traumatic Brain Injury by Cerebral Oximetry in a Pediatric Emergency Setting

Assessing the Impact of 3% Hypertonic Saline Hyperosmolar Therapy on Intubated Children With Isolated Traumatic Brain Injury by Cerebral Oximetry in a Pediatric Emergency Setting

Capnometry levels as an indicator of renal graft evolution in uncontrolled non-heart beating donors

The Effect of Chronic Pulmonary Disease and Mechanical Ventilation on Corneal Donor Endothelial Cell Density and Transplant Suitability

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