Multimodal Online Monitoring in Middle Cerebral Artery Territory Stroke

Steiner, Thorsten; Pilz, Jochen; Schellinger, Peter D.; Wirtz, Rainer; Friederichs, Vera; Aschoff, A.; Hacke, Werner

doi:10.1161/hs1101.097400

Cited by 49 publications

(26 citation statements)

References 45 publications

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“…This was associated with substantial increase in CPP and brain tissue oxygen pressure in both the ischemic and the nonischemic hemisphere. 22 Several concerns have to be considered when using mannitol in stroke patients. Theoretically, the effectiveness of osmotherapy depends on an intact BBB and hypertonic solutions may cause a preferential shrinkage of normal hemisphere where BBB is still intact, with a subsequent worsening of tissue shifts.…”

Section: Bardutzky and Schwabmentioning

confidence: 99%

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Antiedema Therapy in Ischemic Stroke

Bardutzky

Schwab

2007

Stroke

174

103

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Abstract-Life-threatening, space-occupying brain edema occurs in up to 10% of patients with supratentorial infarcts and is traditionally associated with a high mortality rate of up to 80%. Management of these patients is currently being changed to an earlier and more aggressive treatment regimen. Early surgical decompression has recently been proven effective to reduce mortality and increase the number of patients with a favorable outcome in randomized controlled trials and is now the "antiedema" therapy of first choice for patients with large middle cerebral artery infarction aged 60 years or younger. Several medical treatment strategies have been proposed to control brain edema and reduce intracranial pressure, including different osmotherapeutics, hyperventilation, tromethamine, hypothermia, and barbiturate coma. None of these treatments is supported by level 1 evidence of efficacy in clinical trials, and some of them may even be detrimental. Preliminary results on hypothermia for space-occupying hemispheric infarction are encouraging, but far from definitive. (Stroke. 2007;38:3084-3094.)

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Section: Bardutzky and Schwabmentioning

confidence: 99%

“…A range between 310 and 320 mOsm/L has been commonly recommended as target serum osmolality, 22,26 and the maximum tolerable threshold is generally believed to be 320 mOsm/L. However, this practice is not supported by systemic experimental or clinical studies.…”

Section: Bardutzky and Schwabmentioning

confidence: 99%

Antiedema Therapy in Ischemic Stroke

Bardutzky

Schwab

2007

Stroke

174

103

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“…Furthermore, it is described to survey cerebral oxygenation for treating increased intracranial pressure [11,18,21,24,26,27]. The risk for cerebral ischemia due to reduced cerebral blood flow can also be monitored by this method following subarachnoid haemorrhage [2,5,7,9,10,17] and stroke [6,19]. Two currently available systems are based on different technologies: an electrochemical pO 2 -sensor (Licox, LX) and a fluorescent pO 2 -sensor (Neurotrend, NT).…”

Section: Introductionmentioning

confidence: 99%

Brain oxygen monitoring: in-vitro accuracy, long-term drift and response-time of Licox- and Neurotrend sensors

Hoelper

Alessandri

Heimann

et al. 2005

Acta Neurochir (Wien)

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SummaryBackground. Oxygen tension sensors have been used to monitor tissue oxygenation in human brain for several years. The working principals of the most frequently used sensors, the Licox (LX) and Neurotrend (NT), are different, and they have never been validated independently for correct measurement in vitro. Therefore, we tried to clarify if the two currently available sensors provide sufficient accuracy and stability.Method. 12 LX oxygen tension sensors and NT sensors were placed into a liquid-filled tonometer chamber. The solution was kept at 37 AE 0.2 C and equilibrated with five calibration gases containing different O 2 -and CO 2 -concentrations. After equilibration, readings were taken for each gas concentration (accuracy test). Afterwards, the sensors were left in 3% O 2 and 9% CO 2 and readings were taken after 24, 48, 72, 96 and 120 hours (drift test). Thereafter, a 90% response time test was performed transferring sensors from 1% to 5% oxygen concentration and back, using pre-equilibrated tonometers.Findings. All Licox oxygen probes [12] were used for this study. Two of 14 Neurotrend sensors did not calibrate, revealing a failure rate of 14% for NT. Oxygen tension during the accuracy test was measured as follows: 1% O 2 (7.1 mmHg): LX 6.5 AE 0.4, NT 5.3 AE 2.3 mmHg, 2% O 2 (14.2 mmHg): LX 12.9 AE 0.6, NT 12.1 AE 2.2 mmHg, 3% O 2 (21.4 mmHg): LX 19.8 AE 0.7, NT 19.4 AE 2.4 mmHg, 5% O 2 (35.8 mmHg): LX 33.4 AE 1.0 mmHg, NT 33.5 AE 2.9 mmHg, 8% O 2 (57.0 mmHg): 53.8 AE 1.5, NT 53.6 AE 3.3 mmHg. After 120 hours in 3% O 2 (21 mmHg), LX measured 19.8 AE 1.9 mmHg, NT 17.9 AE 4.7 mmHg. 90% response time from 1% to 5%=5% to 1% oxygen concentration was 129 AE 27=174 AE 26 sec for LX, 55 AE 19=98 AE 39 sec for NT.Conclusions. Both systems are measuring oxygen tension sufficiently, but more accurately with LX probes. NT sensors read significantly lower pO 2 in 1% O 2 and show an increasing deviation with higher oxygen concentrations which was due to two of twelve probes. A slight drift towards lower oxygen tension readings for both sensors but more pronounced for the NT does not impair long-term use. NT measures pCO 2 and pH very accurately.

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“…Infartos encefálicos extensos 6,8,26,28,30 e traumatismo cranioencefálico 7,15.16,17,22,33,37 acometendo mais homens, e hemorragia subaracnóidea afetando mais as mulheres são informações condizentes com as da literatura, notandose que, se de alguma forma os riscos para TCE fossem minimizados, certamente o número de mulheres com necessidade de monitorização da PIC seria maior que o de homens, possivelmente em decorrência de HSA espontânea (Tabelas 2 e 3).…”

Section: Discussionunclassified

Untitled

2004

Arq Bras Neurocir

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Multimodal Online Monitoring in Middle Cerebral Artery Territory Stroke

Cited by 49 publications

References 45 publications

Antiedema Therapy in Ischemic Stroke

Antiedema Therapy in Ischemic Stroke

Brain oxygen monitoring: in-vitro accuracy, long-term drift and response-time of Licox- and Neurotrend sensors

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