Cerebral tissue oxygenation measured by two different probes: challenges and interpretation

Tumor hypoxia is a well-established biological phenomenon that affects the curability of solid tumors, regardless of treatment modality. Especially for head and neck cancer patients, tumor hypoxia is linked to poor patient outcomes. Given the biological problems associated with tumor hypoxia, the goal for clinicians has been to identify moderately to severely hypoxic tumors for differential treatment strategies. The ''gold standard'' for detecting and characterizing of tumor hypoxia are the invasive polarographic electrodes. Several less invasive hypoxia assessment techniques have also shown promise for hypoxia assessment. The widespread incorporation of hypoxia information in clinical tumor assessment is severely impeded by several factors, including regulatory hurdles and unclear correlation with potential treatment decisions. There is now an acute need for approved diagnostic technologies for determining the hypoxia status of cancer lesions, as it would enable clinical development of personalized, hypoxia-based therapies, which will ultimately improve outcomes. A number of different techniques for assessing tumor hypoxia have evolved to replace polarographic pO 2 measurements for assessing tumor hypoxia. Several of these modalities, either individually or in combination with other imaging techniques, provide functional and physiological information of tumor hypoxia that can significantly improve the course of treatment. The assessment of tumor hypoxia will be valuable to radiation oncologists, surgeons, and biotechnology and pharmaceutical companies who are engaged in developing hypoxia-based therapies or treatment strategies. Antioxid. Redox Signal. 21, 1516-1554.

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“…These instruments monitor regional pO 2 concentrations in brain tissue (63) and surface accessible tumors (110).…”

Section: The Clinical Importance Of Assessing Tumor Hypoxiamentioning

confidence: 99%

The Clinical Importance of Assessing Tumor Hypoxia: Relationship of Tumor Hypoxia to Prognosis and Therapeutic Opportunities

Walsh

Lebedev

Aten³

et al. 2014

Antioxidants & Redox Signaling

353

317

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“…This was not confirmed in a preliminary report in 11 mixed TBI and SAH patients [261]. They increased MAP by 20 mmHg for 10 min and varied FiO2 and they report that pbtO2 differed significantly at all times.…”

Section: Definition Of Normal and Pathological Values -A Complex Taskmentioning

confidence: 70%

“…Mean Licox values were 6.1 mmHg lower than Neurovent values". They conclude that: "These data therefore do not support the view that both probes can be used interchangeably" [261].…”

Section: Definition Of Normal and Pathological Values -A Complex Taskmentioning

confidence: 82%

“…It has even been said to be "… as close to a gold standard of cerebral oxygenation as we have at the bedside" [233]. The Licox Clark type electrode is considered a reference or "gold standard" electrode in experimental setups [247,261]. All but one review indicate that this technology is useful for routine clinical practise [206].…”

Section: Pbto2 Monitoring Reviews and Critical Appraisalmentioning

confidence: 99%

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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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“…Raumedic (Muenchberg, Germany) recently introduced the optical technique-based Neurovent-TO Ò and Neurovent-PTO Ò probes, with combined assessment of temperature, Pbro 2 , and ICP (PTO). Results from preclinical in vitro and in vivo experiments have been promising (Orakcioglu et al, 2010;Purins et al, 2010), and some initial cases of its clinical use have been reported (Dengler et al, 2011;Huschak et al, 2009). Another optical-technique probe used in experimental studies on brain tissue oxygenation is the OxyLite Ò sensor, developed and distributed by Oxford Optronix (Oxford, U.K.; Doll et al, 2009;Nwaigwe et al, 2000).…”

Section: Monitoring Brain Tissue Oxygenationmentioning

confidence: 97%

Brain Tissue Oxygen Monitoring and Hyperoxic Treatment in Patients with Traumatic Brain Injury

Beynon

Kiening

Orakcioglu

et al. 2012

Journal of Neurotrauma

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Cerebral ischemia is a well-recognized contributor to high morbidity and mortality after traumatic brain injury (TBI). Standard of care treatment aims to maintain a sufficient oxygen supply to the brain by avoiding increased intracranial pressure (ICP) and ensuring a sufficient cerebral perfusion pressure (CPP). Devices allowing direct assessment of brain tissue oxygenation have showed promising results in clinical studies, and their use was implemented in the Brain Trauma Foundation Guidelines for the treatment of TBI patients in 2007. Results of several studies suggest that a brain tissue oxygen-directed therapy guided by these monitors may contribute to reduced mortality and improved outcome of TBI patients. Whether increasing the oxygen supply to supraphysiological levels has beneficial or detrimental effects on TBI patients has been a matter of debate for decades. The results of trials of hyperbaric oxygenation (HBO) have failed to show a benefit, but renewed interest in normobaric hyperoxia (NBO) in the treatment of TBI patients has emerged in recent years. With the increased availability of advanced neuromonitoring devices such as brain tissue oxygen monitors, it was shown that some patients might benefit from this therapeutic approach. In this article, we review the pathophysiological rationale and technical modalities of brain tissue oxygen monitors, as well as its use in studies of brain tissue oxygen-directed therapy. Furthermore, we analyze hyperoxia as a treatment option in TBI patients, summarize the results of clinical trials, and give insights into the recent findings of hyperoxic effects on cerebral metabolism after TBI.

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Cerebral tissue oxygenation measured by two different probes: challenges and interpretation

Cited by 35 publications

References 22 publications

The Clinical Importance of Assessing Tumor Hypoxia: Relationship of Tumor Hypoxia to Prognosis and Therapeutic Opportunities

The Clinical Importance of Assessing Tumor Hypoxia: Relationship of Tumor Hypoxia to Prognosis and Therapeutic Opportunities

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

Brain Tissue Oxygen Monitoring and Hyperoxic Treatment in Patients with Traumatic Brain Injury

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