Monitoring brain tissue oxygen tension in brain-injured patients reveals hypoxic episodes in normal-appearing and in peri-focal tissue

Longhi, Luca; Pagan, Francesca; Valeriani, V.; Magnoni, Sandra; Zanier, Elisa R.; Conte, V.; Branca, V.; Stocchetti, Nino

doi:10.1007/s00134-007-0845-2

Cited by 85 publications

(45 citation statements)

References 35 publications

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“…Hypoxia-sensitive transcription of Sur1 thus reinforces mechanosensitive transcription of Sur1. Hypoxia/ischemia is a common occurrence in brain regions surrounding a contusion (Dietrich et al, 1998;Engel et al, 2008;Longhi et al, 2007), further emphasizing the important role of Sur1 in contusive brain injury.…”

Section: Fig 4 Delayed Capillary Fragmentation Accounts For Hemorrhmentioning

confidence: 99%

Hemorrhagic Progression of a Contusion after Traumatic Brain Injury: A Review

Kurland

Hong

Aarabi

et al. 2012

Journal of Neurotrauma

286

220

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Кафедра нейрохірургії, Національна медична академія післядипломної освіти імені П.Л. Шупика МОЗ України, Київ, Україна 2 Нейрохірургічне відділення №1, Київська міська клінічна лікарня швидкої медичної допомоги, Київ, Україна Вторинна геморагічна прогресія вогнищ забою головного мозку у пацієнтів при черепно-мозковій травмі Вступ. Вторинні післятравматичні зміни головного мозку (ГМ) часто є визначальними в клінічному перебігу черепно-мозкової травми (ЧМТ). Попередження, виявлення та визначення лікувальної тактики при вторинній геморагічній прогресії забою (ВГПЗ) ГМ актуальні для нейротравматології. Матеріали і методи. Проаналізовані результати лікування потерпілих з ЧМТ, у яких діагностований забій ГМ. Результати. Встановлено, що ВГПЗ виникає у 50% пацієнтів при ЧМТ, як у місцях первинного ушкодження ГМ, так і у віддалених зонах за принципом протиудару протягом 12 год, хоча може виникати і через 3-4 доби після травми. ВГПЗ часто виявляють у пацієнтів з субдуральною гематомою (СДГ). Чим більше вогнище забою, тим більша ймовірність його прогресії та необхідності хірургічної декомпресії. Висновки. ВГПЗ є одним з найважливіших ускладнень після ЧМТ, пов'язана з значним підвищенням ризику клінічного погіршення. Лікувальна тактика залежить від вираженості впливу на навколишні структури та проявів компресійно-дислокаційного синдрому. Ключові слова: тяжка черепно-мозкова травма, забій головного мозку, вторинна геморагічна прогресія вогнищ забою, внутрішньочерепний тиск, ішемічні розлади. Introduction. Secondary posttraumatic changes of the brain often are determining in the clinical flow of traumatic brain injury (TBI). Prevention, detection and determination of treatment strategy at secondary hemorrhagic progression of contusion (SHPC) are very actual for neurotraumatology. Materials and methods. The results of 110 injured persons with TBI were analyzed. Results. It was found that SHPC occurs in 50% patients with TBI, as in areas of primary brain damage as in remote areas on the other side of the brain during 12 h ad also after 3-4 days. SHPC often is revealed in patients with subdural hematoma. The bigger contusion foci, the higher the probability of their progression and the need of surgical decompression. Conclusions. SHPC is one of most important TBI complications associated with considerable risk of clinical deterioration and serious cause of morbidity and lethality. Treatment tactics depends on severity of volumetric effect on surrounding brain structures and manifestations of compression-dislocation syndrome.

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Section: Fig 4 Delayed Capillary Fragmentation Accounts For Hemorrhmentioning

confidence: 99%

Hemorrhagic Progression of a Contusion after Traumatic Brain Injury: A Review

Kurland

Hong

Aarabi

et al. 2012

Journal of Neurotrauma

286

220

View full text Add to dashboard Cite

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“…During intraoperative aneurysm surgery and ICU treatment probe placement in the territory of the aneurysm harboring vessel has been advocated [44,62,63]. As expected pbtO2 is lower in peri-contusional tissue than in normal appearing tissue on CT scanning in TBI patients [253]. Some groups, however, prefer measurements contralateral to the side of mass lesions [18,39].…”

Section: Catheter Placement and Sampling Sizementioning

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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“…These data, obtained as a snapshot, can be integrated with focal monitoring, PtiO 2 , TD-rCBF or microdialysis, especially if placed in the injured tissue [6][7][8]. Unfortunately, interpretation of regional monitoring is sometimes hypothetical because not coupled to rCBF measurement [130]. We can suppose that, in the future, as a consequence, an interplay between imaging and focal monitoring will become a daily occurrence: focal disturbance can be detected by imaging and guide the placement of focal monitoring.…”

Section: The Future Of Xe-ct In Tbi Patientsmentioning

confidence: 99%

A Practical Approach to Interpretation of CBF Measured by Mean of Xenon-CT in Patients with Traumatic Brain Injury

Chieregato¹,

Tanfani²,

Fainardi³

2010

TONEUROSJ

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Abstract:The measurement of cerebral blood flow (CBF) in traumatic brain injury (TBI) by means of Xenon-CT (Xe-CT) has been part of the clinical practice of several centres since 1980. Xe-CT consists of a CBF image coupled with CT which offers the possibility to associate morphologic features given by CT with functional information. Today, Xe-CT, in association with Positron Emission Tomography (PET), represents the gold standard for clinical quantitative measurement of CBF. More recently, Xe-CT has improved its potential application in the intensive care unit by means of portable CT scanner. The aim of the present review is to describe the practical experience of a single center with over five hundred Xe-CT studies obtained in more than two hundred TBI patients, to provide a method to guide the lecture of images at bedside, to present illustrative cases and to review the literature published so far on Xe-CT and TBI. The physiological and clinical variables which may be useful to explain global and regional CBF are detailed. Global CBF and its relationship with ageing, the natural time course in TBI, and the dependency on physiological variables and therapy are discussed. The coupling of global CBF with cerebral metabolic rate of oxygen (CMRO2) and the relationship of arterial venous oxygen content differences (AVDO2) with patient outcome are analyzed. Finally, the current knowledge on regional CBF found in the most important traumatic lesions (posttraumatic cerebral infarction, contusion/laceration, acute subdural hematomas, and intraparenchymal hematoma) is described.Keywords: Arteriovenous difference of oxygen, cerebral blood flow, cerebral metabolic rate of oxygen, ischemia, outcome, traumatic brain injury, Xenon CT.

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Monitoring brain tissue oxygen tension in brain-injured patients reveals hypoxic episodes in normal-appearing and in peri-focal tissue

Cited by 85 publications

References 35 publications

Hemorrhagic Progression of a Contusion after Traumatic Brain Injury: A Review

Hemorrhagic Progression of a Contusion after Traumatic Brain Injury: A Review

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

A Practical Approach to Interpretation of CBF Measured by Mean of Xenon-CT in Patients with Traumatic Brain Injury

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