Monitoring of Brain and Systemic Oxygenation in Neurocritical Care Patients

Oddo, Mauro; Bösel, Julian

doi:10.1007/s12028-014-0024-6

Cited by 93 publications

(65 citation statements)

References 309 publications

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“…Transcranial Doppler sonography has been shown to predict symptomatic vasospasm in the middle cerebral artery with good sensitivity (64%) and specificity (78%), but was less accurate in predicting anterior cerebral artery vasospasm (sensitivity 45% and specificity 84%) 26 . Besides transcranial Doppler sonography, ptiO 2 monitoring and cerebral microdialysis are widely accepted as diagnostic tool for early detection of DCI 5,6 . In this study, we compared CBF, CBV and mttICG measurements obtained by the NIRS-ICP probe with and without DCI.…”

Section: Discussionmentioning

confidence: 99%

“…Because all patients in this study were comatose and/or sedated, the definition of DCI was based on findings of ptiO 2 measurements and microdialysis as previously reported 5,6 . Thus DCI was defined as cerebral hypoxia (ptiO 2 <20 mmHg) and/or metabolic compromise (glucose level <1.0 mmol/l and lactate/pyruvate ratio >35), indicating secondary ischemia with increased risk of further brain damage.…”

Section: Definition Of DCImentioning

confidence: 99%

“…In recent years, accumulating clinical evidence suggests that multimodal neuromonitoring including cerebral blood flow (CBF), oxygenation and metabolism can help to avoid delayed cerebral ischemia (DCI) in individual patients [4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage

et al. 2016

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Objective: To evaluate a brain tissue probe for intracranial pressure (ICP) and temperature (TEMP) monitoring as well as determination of cerebral hemodynamics using a near infrared spectroscopy (NIRS) and indocyanine green (ICG) dye dilution method (NIRS-ICP probe). Methods: The NIRS-ICP probe was applied after aneurysmal subarachnoid hemorrhage if multimodal monitoring was established due to poor neurological condition. ICP and TEMP values were obtained from ventricular catheters and systemic temperature sensors. Repeated NIRS-ICG measurements (2 injections within 30 minutes) were performed daily for determination of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time of ICG (mttICG). Delayed cerebral ischemia was defined as brain tissue oxygen tension <20 mmHg and/or lactate-pyruvate-ratio >35. Results: A total of 128 NIRS-ICG measurements were performed in 10 patients. The correlation coefficient between ICP and TEMP values obtained with the NIRS-ICP probe and values from routine monitoring was r=0.72 and r=0.96, respectively. The mean value was 30.3 ± 13.6 ml/100g/min for CBF, 3.3 ± 1.2 ml/100g for CBV, and 6.8 ± 1.6 sec for mttICG. The coefficient of variation from repeated NIRS-ICG measurements was 10.9% for CBF, 11.7% for CBV, and 3.8% for mttICG. The sensitivity for delayed cerebral ischemia detection was 85% and the specificity 83% using a CBFthreshold of 25 ml/100g/min. Conclusion: Multimodal monitoring using the NIRS-ICP probe is feasible with high reproducibility of measurement values and the ability to detect delayed cerebral ischemia. No safety concerns exist for the routine clinical use of the NIRS-ICP probe. monitoring as well as determination of cerebral hemodynamics using a near infrared spectroscopy (NIRS) and indocyanine green (ICG) dye dilution method (NIRS-ICP probe). Methods:The NIRS-ICP probe was applied after aneurysmal subarachnoid hemorrhage if multimodal monitoring was established due to poor neurological condition. ICP and TEMP values were obtained from ventricular catheters and systemic temperature sensors. Repeated NIRS-ICG measurements (2 injections within 30 minutes) were performed daily for determination of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time of ICG (mttICG). Delayed cerebral ischemia was defined as brain tissue oxygen tension <20 mmHg and/or lactate-pyruvate-ratio >35.Results: A total of 128 NIRS-ICG measurements were performed in 10 patients. The correlation coefficient between ICP and TEMP values obtained with the NIRS-ICP probe and values from routine monitoring was r=0.72 and r=0.96, respectively. The mean value was 30.3 ± 13.6 ml/100g/min for CBF, 3.3 ± 1.2 ml/100g for CBV, and 6.8 ± 1.6 sec for mttICG. The coefficient of variation from repeated NIRS-ICG measurements was 10.9% for CBF, 11.7% for CBV, and 3.8% for mttICG. The sensitivity for delayed cerebral ischemia detection was 85% and the specificity 83% using a CBFthreshold of 25 ml/100g/min. Conclusion:Multimodal monitoring using the NIRS-ICP...

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Section: Discussionmentioning

confidence: 99%

Section: Definition Of DCImentioning

confidence: 99%

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Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage

et al. 2016

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“…S jvO 2 desaturation, defined as a value of Ͻ50 -55% for Ͼ10 min, has been associated with poor neurologic outcome. [19][20][21] Conversely, an S jvO 2 elevated Ͼ75% is also associated with poor outcome in patients with severe TBI. 20 Due to the association between abnormal values and poor outcome, S jvO 2 has been used as a primary outcome in clinical trials.…”

Section: How Should Brain Tissue Oxygen Be Measured?mentioning

confidence: 99%

Brain Tissue Oxygen Monitoring and the Intersection of Brain and Lung: A Comprehensive Review

2016

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SummaryTraumatic brain injury is a problem that affects millions of Americans yearly and for which there is no definitive treatment that improves outcome. Continuous brain tissue oxygen (P btO 2 ) monitoring is a complement to traditional brain monitoring techniques, such as intracranial pressure and cerebral perfusion pressure. P btO 2 monitoring has not yet become a clinical standard of care, due to several unresolved questions. In this review, we discuss the rationale and technology of P btO 2 monitoring. We review the literature, both historic and current, and show that continuous P btO 2 monitoring is feasible and useful in patient management. P btO 2 numbers reflect cerebral blood flow and oxygen diffusion. Thus, continuous monitoring of P btO 2 yields important information about both the brain and the lung. The preclinical and clinical studies demonstrating these findings are discussed. In this review, we demonstrate that patient management in a P btO 2 -directed fashion is not the sole answer to the problem of treating traumatic brain injury but is an important adjunct to the armamentarium of multimodal neuromonitoring.

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“…Normocapnia should be maintained during intubation, and early correlation of an arterial CO 2 sample with ETCO 2 is suggested to enable non-invasive tracking of ventilation [1,27].…”

Section: Intubating the Patient With Brain Ischemiamentioning

confidence: 99%

Emergency Neurological Life Support: Airway, Ventilation, and Sedation

Seder

Jagoda

2015

Neurocrit Care

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Airway management and ventilation are central to the resuscitation of the neurologically ill. These patients often have evolving processes that threaten the airway and adequate ventilation. Furthermore, intubation, ventilation, and sedative choices directly affect brain perfusion. Therefore, airway, ventilation, and sedation was chosen as an emergency neurological life support protocol. Topics include airway management, when and how to intubate with special attention to hemodynamics and preservation of cerebral blood flow, mechanical ventilation settings, and the use of sedative agents based on the patient's neurological status.

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Monitoring of Brain and Systemic Oxygenation in Neurocritical Care Patients

Cited by 93 publications

References 309 publications

Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage

Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage

Brain Tissue Oxygen Monitoring and the Intersection of Brain and Lung: A Comprehensive Review

Emergency Neurological Life Support: Airway, Ventilation, and Sedation

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