Monitoring cerebral oxygenation in acute brain-injured patients

Robba, Chiara; Taccone, Fabio Silvio; Citerio, Giuseppe

doi:10.1007/s00134-022-06788-w

Cited by 27 publications

(18 citation statements)

References 16 publications

(21 reference statements)

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“…In acute brain injury, monitoring includes SjvO 2 , near-infrared spectroscopy (NIRS) and brain tissue partial pressure of oxygen (PbtO 2 ). 17,18 A PbtO 2 <20 mmHg is considered a trigger for intervention. 18 NIRS can also be used to target cerebral and muscular tissue oxygenation (StO 2 ) in postcardiac arrest, surgical and septic patients but the evidence was conflicting.…”

Section: Basic Monitoringmentioning

confidence: 99%

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Respiratory Monitoring During Mechanical Ventilation: The Present and the Future

Roshdy

2023

J Intensive Care Med

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The increased application of mechanical ventilation, the recognition of its harms and the interest in individualization raised the need for an effective monitoring. An increasing number of monitoring tools and modalities were introduced over the past 2 decades with growing insight into asynchrony, lung and chest wall mechanics, respiratory effort and drive. They should be used in a complementary rather than a standalone way. A sound strategy can guide a reduction in adverse effects like ventilator-induced lung injury, ventilator-induced diaphragm dysfunction, patient-ventilator asynchrony and helps early weaning from the ventilator. However, the diversity, complexity, lack of expertise, and associated cost make formulating the appropriate monitoring strategy a challenge for clinicians. Most often, a big amount of data is fed to the clinicians making interpretation difficult. Therefore, it is fundamental for intensivists to be aware of the principle, advantages, and limits of each tool. This analytic review includes a simplified narrative of the commonly used basic and advanced respiratory monitors along with their limits and future prospective.

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Section: Basic Monitoringmentioning

confidence: 99%

“…17,18 A PbtO 2 <20 mmHg is considered a trigger for intervention. 18 NIRS can also be used to target cerebral and muscular tissue oxygenation (StO 2 ) in postcardiac arrest, surgical and septic patients but the evidence was conflicting. 19–21…”

Section: Basic Monitoringmentioning

confidence: 99%

Respiratory Monitoring During Mechanical Ventilation: The Present and the Future

Roshdy

2023

J Intensive Care Med

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“…Acceptable CPP levels do not ensure normal brain oxygenation, since there is evidence that brain tissue hypoxia can occur even with normal MABP and ICP values [ 5 ]. Furthermore, the concept of personalization of treatment is gaining interest, based on the concept that clinicians should not only consider a common pathophysiological pathway independently from specific brain damage but should adapt the therapeutic management to specific needs [ 23 – 26 ]. For example, one parameter to be considered could be the volume of the contusion [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

“THE MANTLE” bundle for minimizing cerebral hypoxia in severe traumatic brain injury

et al. 2023

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To ensure neuronal survival after severe traumatic brain injury, oxygen supply is essential. Cerebral tissue oxygenation represents the balance between oxygen supply and consumption, largely reflecting the adequacy of cerebral perfusion. Multiple physiological parameters determine the oxygen delivered to the brain, including blood pressure, hemoglobin level, systemic oxygenation, microcirculation and many factors are involved in the delivery of oxygen to its final recipient, through the respiratory chain. Brain tissue hypoxia occurs when the supply of oxygen is not adequate or when for some reasons it cannot be used at the cellular level. The causes of hypoxia are variable and can be analyzed pathophysiologically following “the oxygen route.” The current trend is precision medicine, individualized and therapeutically directed to the pathophysiology of specific brain damage; however, this requires the availability of multimodal monitoring. For this purpose, we developed the acronym “THE MANTLE,” a bundle of therapeutical interventions, which covers and protects the brain, optimizing the components of the oxygen transport system from ambient air to the mitochondria.

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“…Among the different neuromonitoring methods [8][9][10], the use of cerebral oxygenation has been recently suggested [11]. Of course the use of cerebral oximetry is not new as it has been a mainstay of managing patient with traumatic brain injury for years, and there are three methods currently available: jugular bulb saturation, which allows an estimation of global oxygenation and require an invasive catheter to be positioned in the jugular bulb; brain tissue oxygenation, which is now considered the gold standard and measures focal oxygenation through a Clark electrode; Near-infrared spectroscopy (NIRS), which measures tissue oximetry non invasively providing an estimate of the balance between oxygen delivery and metabolic needs of the brain.…”

Section: Introductionmentioning

confidence: 99%

The importance of monitoring cerebral oxygenation in non brain injured patients

Robba

Battaglini

Rasulo

et al. 2023

J Clin Monit Comput

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Over the past few years, the use of non-invasive neuromonitoring in non-brain injured patients has increased, as a result of the recognition that many of these patients are at risk of brain injury in a wide number of clinical scenarios and therefore may benefit from its application which allows interventions to prevent injury and improve outcome. Among these, are post cardiac arrest syndrome, sepsis, liver failure, acute respiratory failure, and the perioperative settings where in the absence of a primary brain injury, certain groups of patients have high risk of neurological complications. While there are many neuromonitoring modalities utilized in brain injured patients, the majority of those are either invasive such as intracranial pressure monitoring, require special skill such as transcranial Doppler ultrasonography, or intermittent such as pupillometry and therefore unable to provide continuous monitoring. Cerebral oximetry using Near infrared Spectroscopy, is a simple non invasive continuous measure of cerebral oxygenation that has been shown to be useful in preventing cerebral hypoxemia both within the intensive care unit and the perioperative settings. At present, current recommendations for standard monitoring during anesthesia or in the general intensive care concentrate mainly on hemodynamic and respiratory monitoring without specific indications regarding the brain, and in particular, brain oximetry. The aim of this manuscript is to provide an up-to-date overview of the pathophysiology and applications of cerebral oxygenation in non brain injured patients as part of non-invasive multimodal neuromonitoring in the early identification and treatment of neurological complications in this population.

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Monitoring cerebral oxygenation in acute brain-injured patients

Cited by 27 publications

References 16 publications

Respiratory Monitoring During Mechanical Ventilation: The Present and the Future

Respiratory Monitoring During Mechanical Ventilation: The Present and the Future

“THE MANTLE” bundle for minimizing cerebral hypoxia in severe traumatic brain injury

The importance of monitoring cerebral oxygenation in non brain injured patients

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