High Cerebral Perfusion Pressure Improves Low Values of Local Brain Tissue O2 Tension (PtiO2) in Focal Lesions

Stocchetti, Nino; Chieregato, Arturo; Marchi, M. De; Croci, M.; Benti, Riccardo; Grimoldi, N.

doi:10.1007/978-3-7091-6475-4_47

Cited by 48 publications

(35 citation statements)

References 9 publications

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“…The method has been validated for use in humans and has been confirmed as a reliable and stable indicator of local oxygenation (Dings et al, 1997(Dings et al, , 1998. PtiO 2 monitoring is useful to assess the efficacy of treatments based on their ability to restore adequate ptiO 2 levels (Kiening et al, 1997;Zauner et al, 1997;Stocchetti et al, 1998).…”

Section: Introduction Imentioning

confidence: 99%

Brain Oxygen Tension, Oxygen Supply, and Oxygen Consumption During Arterial Hyperoxia in a Model of Progressive Cerebral Ischemia

Rossi

Stocchetti

Longhi

et al. 2001

Journal of Neurotrauma

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We investigated the changes in brain oxygen tension (ptiO 2 ) after ventilation with pure O 2 in order to (1) clarify the pathophysiology of O 2 exchange in the cerebral microcirculation; and (2) investigate the relationship between brain O 2 tension, O 2 delivery, and consumption in steady-state conditions during stepwise cerebral blood flow (CBF) reductions. A swine model was developed to reduce CBF in three stable steps: (1) baseline (CBF 100%), (2) CBF of 50-60% of baseline, and (3) CBF of ,30% of baseline. CBF was reduced by infusing saline into the left lateral ventricle through a catheter connected with an infusion pump. At each step, hyperoxia was tested by increasing the inspired oxygen fraction up to 100%, PtiO 2 reflected the CBF reductions, since it was respectively 27.95 (6 10.15), 14.77 (6 3.58), and 3.45 (6 2.89) mm Hg during the three CBF steps. Hyperoxia was followed by an increase in ptiO 2 , although the increase was significantly lower when hyperoxia was applied during progressive ischemia. O 2 supply to the brain did not change during hyperoxia. Arteriovenous oxygen difference (AVDO 2 ) decreased during the phases of intact CBF and moderate impairment, but not during the phase of severe CBF reduction. In conclusion, ptiO 2 reductions closely reflect the imbalance between oxygen delivery and demand; this implies a link between low ptiO 2 and defective O 2 supply due to impaired CBF. However, this relation is not necessarily reciprocal, since manipulating brain oxygen tension does not always influence brain oxygen delivery, as in the case of ventilation with pure oxygen.

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Section: Introduction Imentioning

confidence: 99%

Brain Oxygen Tension, Oxygen Supply, and Oxygen Consumption During Arterial Hyperoxia in a Model of Progressive Cerebral Ischemia

Rossi

Stocchetti

Longhi

et al. 2001

Journal of Neurotrauma

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“…They found that cerebral oxygenation was an independent predictor of outcome. Stochetti et al found in 9 patients with focal cerebral contusions that several had abnormal PbtO2 in spite of the ICP and the CPP being in the normal range [18].…”

Section: Discussionmentioning

confidence: 99%

Cerebral Oxygen Desaturation with Normal ICP and CPP in Severe TBI

Palmer¹,

Bader²

2008

TOCCMJ

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Abstract:Introduction: Standard monitoring of severe traumatic brain injury patients (TBI) by intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring fails to recognize episodes of cerebral oxygen desaturation. We found and characterized frequent episodes of desaturation of jugular venous oxygen (SjO2) in the face of normal ICP and CPP.Methods: Fifty six patients with severe TBI had SjO2 and ICP monitors placed. The charts were retrospectively reviewed and all episodes of desaturation were recorded and characterized.Results: Nineteen patients had episodes of desaturation with normal ICP and CPP. The average GCS score was 5.8. 63% of desaturations occurred in the first 24 hours, 17% of desaturations occurred in 24-48 hours, and 20% occurred in 48-72 hours. The depth of desaturation was 50-54% in 50% of instances, 45-49% in 37% of instances, and 40-44% in 13% of instances. The duration of the desaturation episodes was less than 10 minutes in 47%, 10-30 minutes in 17%, 30-60 minutes in 23%, and greater than 50 minutes in 13%. Treatment of the desaturation was elevation of FIO2 in all patients, elevation of pCO2 in 15 patients, volume expansion in 9 patients, pressors in 9 patients, and Propofol in 5 patients. Conclusions:The monitoring of severe TBI patients with ICP and CPP alone is insufficient to recognize cerebral oxygen desaturation episodes in 34% of patients. The monitoring of SjO2 facilitates the recognition and treatment of these episodes.

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“…PbrO 2 >36 mmHg is associated with a good outcome, PbrO 2 26-35 mmHg with a significant neurological deficit, and PbrO 2 < 25 mmHg with a poor outcome (18). There are study data suggesting that PbrO 2 is more accurate in detecting compromised perfusion: CPP > 70 mmHg may not always ensure the adequate oxygenation of the affected cerebral region, as reflected by low PbrO 2 (19). PbrO 2 is a powerful neurological outcome predictor (20).…”

Section: Cerebral Oxygenation-directed Techniquesmentioning

confidence: 99%

Multimodal neuromonitoring

Macas¹,

Bilskienė²,

Gembickij³

et al. 2012

AML

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The goal of the intensive care management of a neurosurgical patient is to preserve adequate cerebral perfusion, oxygenation and metabolism in order to prevent secondary neurological injury. In preventing secondary neurological insults interventions must be started early. For many years conventional methods of neuromonitoring have proved their efficacy. However, their sensitivity in detecting subtle metabolic derangements in the real time manner is low and the valuable time for the appropriate treatment is lost. In recent years, there are numerous study data suggesting that implying of advanced neuromonitoring techniques can improve outcomes. Moreover, it helps to guide goal-directed therapy. Although data on advanced neuromonitoring are preliminary and mostly observational, the number of modern neurosurgical centers applying it as a standard is high. With the increasing technical possibilities, the concept of multimodal neuromonitoring is of increasing popularity. Multimodal neuromonitoring allows continuous real time assessment of cerebral perfusion, oxygenation, metabolism and global function which makes it attractive and promising in clinical practice.

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High Cerebral Perfusion Pressure Improves Low Values of Local Brain Tissue O2 Tension (PtiO2) in Focal Lesions

Cited by 48 publications

References 9 publications

Brain Oxygen Tension, Oxygen Supply, and Oxygen Consumption During Arterial Hyperoxia in a Model of Progressive Cerebral Ischemia

Brain Oxygen Tension, Oxygen Supply, and Oxygen Consumption During Arterial Hyperoxia in a Model of Progressive Cerebral Ischemia

Cerebral Oxygen Desaturation with Normal ICP and CPP in Severe TBI

Multimodal neuromonitoring

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