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Published in: Intensive Care Medicine 12/2007

01-12-2007 | Original

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

Authors: Luca Longhi, Francesca Pagan, Valerio Valeriani, Sandra Magnoni, Elisa R. Zanier, Valeria Conte, Vincenzo Branca, Nino Stocchetti

Published in: Intensive Care Medicine | Issue 12/2007

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Abstract

Objective

We compared brain tissue oxygen tension (PtiO2) measured in peri-focal and in normal-appearing brain parenchyma on computerized tomography (CT) in patients following traumatic brain injury (TBI).

Design

Prospective observational study.

Setting

Neurointensive care unit.

Patients and participants

Thirty-two consecutive TBI patients were subjected to PtiO2 monitoring.

Interventions

Peri-focal tissue was identified by the presence of a hypodense area of the contusion and/or within 1 cm from the core of the contusion. The position of the tip of the PtiO2 probe was assessed at follow-up CT scan.

Measurements and results

Mean PtiO2 in the peri-contusional tissue was 19.7 ± 2.1 mmHg and was lower than PtiO2 in normal-appearing tissue (25.5 ± 1.5 mmHg, p < 0.05), despite a greater cerebral perfusion pressure (CPP) (73.7 ± 2.3 mmHg vs. 67.4 ± 1.4 mmHg, p < 0.05). We observed both in peri-focal tissue and in normal-appearing tissue episodes of brain hypoxia (PtiO2 < 20 mmHg for at least 10 min), whose median duration was longer in peri-focal tissue than in normal-appearing tissue (51% vs. 34% of monitoring time, p < 0.01). In peri-focal tissue, we observed a progressive PtiO2 increase from pathologic to normal values (p < 0.01).

Conclusions

Multiple episodes of brain hypoxia occurred over the first 5 days following severe TBI. PtiO2 was lower in peri-contusional tissue than in normal-appearing tissue. In peri-contusional tissue, a progressive increase of PtiO2 from pathologic to normal values was observed over time, suggestive of an improvement at microcirculatory level.
Literature
1.
go back to reference Anonymous (1999) Consensus conference. Rehabilitation of persons with traumatic brain injury. NIH Consensus Development Panel on Rehabilitation of Persons With Traumatic Brain Injury. JAMA 282:974–983CrossRef Anonymous (1999) Consensus conference. Rehabilitation of persons with traumatic brain injury. NIH Consensus Development Panel on Rehabilitation of Persons With Traumatic Brain Injury. JAMA 282:974–983CrossRef
2.
go back to reference Brain Trauma Foundation (2007) Guidelines for the Management of Severe Traumatic Brain Injury. J Neurotrauma 24 [Suppl 1]:S1–S95CrossRef Brain Trauma Foundation (2007) Guidelines for the Management of Severe Traumatic Brain Injury. J Neurotrauma 24 [Suppl 1]:S1–S95CrossRef
3.
go back to reference Bouma GJ, Muizelaar JP, Choi SC, Newlon PG, Young HF (1991) Cerebral circulation and metabolism after severe traumatic brain injury: the elusive role of ischemia. J Neurosurg 75:685–693PubMed Bouma GJ, Muizelaar JP, Choi SC, Newlon PG, Young HF (1991) Cerebral circulation and metabolism after severe traumatic brain injury: the elusive role of ischemia. J Neurosurg 75:685–693PubMed
4.
go back to reference Graham DI, Ford I, Adams JH, Doyle D, Teasdale GM, Lawrence AE, McLellan DR (1989) Ischaemic brain damage is still common in fatal non-missile head injury. J Neurol Neurosurg Psychiatry 52:346–350PubMed Graham DI, Ford I, Adams JH, Doyle D, Teasdale GM, Lawrence AE, McLellan DR (1989) Ischaemic brain damage is still common in fatal non-missile head injury. J Neurol Neurosurg Psychiatry 52:346–350PubMed
5.
go back to reference Yamakami I, McIntosh TK (1989) Effects of traumatic brain injury on regional cerebral blood flow in rats as measured with radiolabeled microspheres. J Cereb Blood Flow Metab 9:117–124PubMed Yamakami I, McIntosh TK (1989) Effects of traumatic brain injury on regional cerebral blood flow in rats as measured with radiolabeled microspheres. J Cereb Blood Flow Metab 9:117–124PubMed
6.
go back to reference Coles JP, Fryer TD, Smielewski P, Chatfield DA, Steiner LA, Johnston AJ, Downey SP, Williams GB, Aigbirhio F, Hutchinson PJ, Rice K, Carpenter TA, Clark JC, Pickard JD, Menon DK (2004) Incidence and mechanisms of cerebral ischemia in early clinical head injury. J Cereb Blood Flow Metab 24:202–211PubMedCrossRef Coles JP, Fryer TD, Smielewski P, Chatfield DA, Steiner LA, Johnston AJ, Downey SP, Williams GB, Aigbirhio F, Hutchinson PJ, Rice K, Carpenter TA, Clark JC, Pickard JD, Menon DK (2004) Incidence and mechanisms of cerebral ischemia in early clinical head injury. J Cereb Blood Flow Metab 24:202–211PubMedCrossRef
7.
go back to reference Bergsneider M, Hovda DA, Shalmon E, Kelly DF, Vespa PM, Martin NA, Phelps ME, McArthur DL, Caron MJ, Kraus JF, Becker DP (1997) Cerebral hyperglycolysis following severe traumatic brain injury in humans: a positron emission tomography study. J Neurosurg 86:241–251PubMed Bergsneider M, Hovda DA, Shalmon E, Kelly DF, Vespa PM, Martin NA, Phelps ME, McArthur DL, Caron MJ, Kraus JF, Becker DP (1997) Cerebral hyperglycolysis following severe traumatic brain injury in humans: a positron emission tomography study. J Neurosurg 86:241–251PubMed
8.
go back to reference Glenn TC, Kelly DF, Boscardin WJ, McArthur DL, Vespa P, Oertel M, Hovda DA, Bergsneider M, Hillered L, Martin NA (2003) Energy dysfunction as a predictor of outcome after moderate or severe head injury: indices of oxygen, glucose, and lactate metabolism. J Cereb Blood Flow Metab 23:1239–1250PubMedCrossRef Glenn TC, Kelly DF, Boscardin WJ, McArthur DL, Vespa P, Oertel M, Hovda DA, Bergsneider M, Hillered L, Martin NA (2003) Energy dysfunction as a predictor of outcome after moderate or severe head injury: indices of oxygen, glucose, and lactate metabolism. J Cereb Blood Flow Metab 23:1239–1250PubMedCrossRef
9.
go back to reference Hutchinson PJ, Gupta AK, Fryer TF, Al Rawi PG, Chatfield DA, Coles JP, O'Connell MT, Kett-White R, Minhas PS, Aigbirhio FI, Clark JC, Kirkpatrick PJ, Menon DK, Pickard JD (2002) Correlation between cerebral blood flow, substrate delivery, and metabolism in head injury: a combined microdialysis and triple oxygen positron emission tomography study. J Cereb Blood Flow Metab 22:735–745PubMedCrossRef Hutchinson PJ, Gupta AK, Fryer TF, Al Rawi PG, Chatfield DA, Coles JP, O'Connell MT, Kett-White R, Minhas PS, Aigbirhio FI, Clark JC, Kirkpatrick PJ, Menon DK, Pickard JD (2002) Correlation between cerebral blood flow, substrate delivery, and metabolism in head injury: a combined microdialysis and triple oxygen positron emission tomography study. J Cereb Blood Flow Metab 22:735–745PubMedCrossRef
10.
go back to reference Martin NA, Patwardhan RV, Alexander MJ, Africk CZ, Lee JH, Shalmon E, Hovda DA, Becker DP (1997) Characterization of cerebral hemodynamic phases following severe head trauma: hypoperfusion, hyperemia, and vasospasm. J Neurosurg 87:9–19PubMed Martin NA, Patwardhan RV, Alexander MJ, Africk CZ, Lee JH, Shalmon E, Hovda DA, Becker DP (1997) Characterization of cerebral hemodynamic phases following severe head trauma: hypoperfusion, hyperemia, and vasospasm. J Neurosurg 87:9–19PubMed
11.
go back to reference Haitsma IK, Maas AI (2002) Advanced monitoring in the intensive care unit: brain tissue oxygen tension. Curr Opin Crit Care 8:115–120PubMedCrossRef Haitsma IK, Maas AI (2002) Advanced monitoring in the intensive care unit: brain tissue oxygen tension. Curr Opin Crit Care 8:115–120PubMedCrossRef
12.
go back to reference Gupta AK, Hutchinson PJ, Al Rawi P, Gupta S, Swart M, Kirkpatrick PJ, Menon DK, Datta AK (1999) Measuring brain tissue oxygenation compared with jugular venous oxygen saturation for monitoring cerebral oxygenation after traumatic brain injury. Anesth Analg 88:549–553PubMedCrossRef Gupta AK, Hutchinson PJ, Al Rawi P, Gupta S, Swart M, Kirkpatrick PJ, Menon DK, Datta AK (1999) Measuring brain tissue oxygenation compared with jugular venous oxygen saturation for monitoring cerebral oxygenation after traumatic brain injury. Anesth Analg 88:549–553PubMedCrossRef
13.
go back to reference Maas AI, Fleckenstein W, de Jong DA, van Santbrink H (1993) Monitoring cerebral oxygenation: experimental studies and preliminary clinical results of continuous monitoring of cerebrospinal fluid and brain tissue oxygen tension. Acta Neurochir Suppl (Wien) 59:50–57 Maas AI, Fleckenstein W, de Jong DA, van Santbrink H (1993) Monitoring cerebral oxygenation: experimental studies and preliminary clinical results of continuous monitoring of cerebrospinal fluid and brain tissue oxygen tension. Acta Neurochir Suppl (Wien) 59:50–57
14.
go back to reference Valadka AB, Gopinath SP, Contant CF, Uzura M, Robertson CS (1998) Relationship of brain tissue PO2 to outcome after severe head injury. Crit Care Med 26:1576–1581PubMedCrossRef Valadka AB, Gopinath SP, Contant CF, Uzura M, Robertson CS (1998) Relationship of brain tissue PO2 to outcome after severe head injury. Crit Care Med 26:1576–1581PubMedCrossRef
15.
go back to reference van den Brink WA, van Santbrink H, Steyerberg EW, Avezaat CJ, Suazo JA, Hogesteeger C, Jansen WJ, Kloos LM, Vermeulen J, Maas AI (2000) Brain oxygen tension in severe head injury. Neurosurgery 46:868–876PubMedCrossRef van den Brink WA, van Santbrink H, Steyerberg EW, Avezaat CJ, Suazo JA, Hogesteeger C, Jansen WJ, Kloos LM, Vermeulen J, Maas AI (2000) Brain oxygen tension in severe head injury. Neurosurgery 46:868–876PubMedCrossRef
16.
go back to reference van Santbrink H, Maas AI, Avezaat CJ (1996) Continuous monitoring of partial pressure of brain tissue oxygen in patients with severe head injury. Neurosurgery 38:21–31PubMedCrossRef van Santbrink H, Maas AI, Avezaat CJ (1996) Continuous monitoring of partial pressure of brain tissue oxygen in patients with severe head injury. Neurosurgery 38:21–31PubMedCrossRef
17.
go back to reference Zauner A, Doppenberg EM, Woodward JJ, Choi SC, Young HF, Bullock R (1997) Continuous monitoring of cerebral substrate delivery and clearance: initial experience in 24 patients with severe acute brain injuries. Neurosurgery 41:1082–1091PubMedCrossRef Zauner A, Doppenberg EM, Woodward JJ, Choi SC, Young HF, Bullock R (1997) Continuous monitoring of cerebral substrate delivery and clearance: initial experience in 24 patients with severe acute brain injuries. Neurosurgery 41:1082–1091PubMedCrossRef
18.
go back to reference Steiner LA, Coles JP, Johnston AJ, Czosnyka M, Fryer TD, Smielewski P, Chatfield DA, Salvador R, Aigbirhio FI, Clark JC, Menon DK, Pickard JD (2003) Responses of posttraumatic pericontusional cerebral blood flow and blood volume to an increase in cerebral perfusion pressure. J Cereb Blood Flow Metab 23:1371–1377PubMedCrossRef Steiner LA, Coles JP, Johnston AJ, Czosnyka M, Fryer TD, Smielewski P, Chatfield DA, Salvador R, Aigbirhio FI, Clark JC, Menon DK, Pickard JD (2003) Responses of posttraumatic pericontusional cerebral blood flow and blood volume to an increase in cerebral perfusion pressure. J Cereb Blood Flow Metab 23:1371–1377PubMedCrossRef
19.
go back to reference Johnston AJ, Steiner LA, Coles JP, Chatfield DA, Fryer TD, Smielewski P, Hutchinson PJ, O'Connell MT, Al Rawi PG, Aigbirihio FI, Clark JC, Pickard JD, Gupta AK, Menon DK (2005) Effect of cerebral perfusion pressure augmentation on regional oxygenation and metabolism after head injury. Crit Care Med 33:189–195PubMedCrossRef Johnston AJ, Steiner LA, Coles JP, Chatfield DA, Fryer TD, Smielewski P, Hutchinson PJ, O'Connell MT, Al Rawi PG, Aigbirihio FI, Clark JC, Pickard JD, Gupta AK, Menon DK (2005) Effect of cerebral perfusion pressure augmentation on regional oxygenation and metabolism after head injury. Crit Care Med 33:189–195PubMedCrossRef
20.
go back to reference Kiening KL, Unterberg AW, Bardt TF, Schneider GH, Lanksch WR (1996) Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue PO2 versus jugular vein oxygen saturation. J Neurosurg 85:751–757PubMedCrossRef Kiening KL, Unterberg AW, Bardt TF, Schneider GH, Lanksch WR (1996) Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue PO2 versus jugular vein oxygen saturation. J Neurosurg 85:751–757PubMedCrossRef
21.
go back to reference Menon DK, Coles JP, Gupta AK, Fryer TD, Smielewski P, Chatfield DA, Aigbirhio F, Skepper JN, Minhas PS, Hutchinson PJ, Carpenter TA, Clark JC, Pickard JD (2004) Diffusion limited oxygen delivery following head injury. Crit Care Med 32:1384–1390PubMedCrossRef Menon DK, Coles JP, Gupta AK, Fryer TD, Smielewski P, Chatfield DA, Aigbirhio F, Skepper JN, Minhas PS, Hutchinson PJ, Carpenter TA, Clark JC, Pickard JD (2004) Diffusion limited oxygen delivery following head injury. Crit Care Med 32:1384–1390PubMedCrossRef
22.
go back to reference Nortje J, Gupta AK (2006) The role of tissue oxygen monitoring in patients with acute brain injury. Br J Anaesth 97:95–106PubMedCrossRef Nortje J, Gupta AK (2006) The role of tissue oxygen monitoring in patients with acute brain injury. Br J Anaesth 97:95–106PubMedCrossRef
23.
go back to reference Stiefel MF, Udoetuk JD, Spiotta AM, Gracias VH, Goldberg A, Maloney-Wilensky E, Bloom S, Le Roux PD (2006) Conventional neurocritical care and cerebral oxygenation after traumatic brain injury. J Neurosurg 105:568–575PubMed Stiefel MF, Udoetuk JD, Spiotta AM, Gracias VH, Goldberg A, Maloney-Wilensky E, Bloom S, Le Roux PD (2006) Conventional neurocritical care and cerebral oxygenation after traumatic brain injury. J Neurosurg 105:568–575PubMed
24.
go back to reference Stocchetti N, Chieregato A, De Marchi M, Croci M, Benti R, Grimoldi N (1998) High cerebral perfusion pressure improves low values of local brain tissue O2 tension (PtiO2) in focal lesions. Acta Neurochir Suppl 71:162–165PubMed Stocchetti N, Chieregato A, De Marchi M, Croci M, Benti R, Grimoldi N (1998) High cerebral perfusion pressure improves low values of local brain tissue O2 tension (PtiO2) in focal lesions. Acta Neurochir Suppl 71:162–165PubMed
25.
go back to reference Zauner A, Daugherty WP, Bullock MR, Warner DS (2002) Brain oxygenation and energy metabolism. I. Biological function and pathophysiology. Neurosurgery 51:289–301PubMedCrossRef Zauner A, Daugherty WP, Bullock MR, Warner DS (2002) Brain oxygenation and energy metabolism. I. Biological function and pathophysiology. Neurosurgery 51:289–301PubMedCrossRef
26.
go back to reference Marshall LF, Marshall SB, Klauber MR, Clark MvB, Eisenberg HM, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1991) A new classification of head injury based on computerized tomography. J Neurosurg [Suppl] 75 Marshall LF, Marshall SB, Klauber MR, Clark MvB, Eisenberg HM, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1991) A new classification of head injury based on computerized tomography. J Neurosurg [Suppl] 75
27.
go back to reference Rose JC, Neill TA, Hemphill JC III (2006) Continuous monitoring of the microcirculation in neurocritical care: an update on brain tissue oxygenation. Curr Opin Crit Care 12:97–102 Rose JC, Neill TA, Hemphill JC III (2006) Continuous monitoring of the microcirculation in neurocritical care: an update on brain tissue oxygenation. Curr Opin Crit Care 12:97–102
28.
go back to reference Schroder ML, Muizelaar JP, Bullock MR, Salvant JB, Povlishock JT (1995) Focal ischemia due to traumatic contusions documented by stable xenon-CT and ultrastructural studies. J Neurosurg 82:966–971PubMed Schroder ML, Muizelaar JP, Bullock MR, Salvant JB, Povlishock JT (1995) Focal ischemia due to traumatic contusions documented by stable xenon-CT and ultrastructural studies. J Neurosurg 82:966–971PubMed
29.
go back to reference Stein SC, Chen XH, Sinson GP, Smith DH (2002) Intravascular coagulation: a major secondary insult in nonfatal traumatic brain injury. J Neurosurg 97:1373–1377PubMed Stein SC, Chen XH, Sinson GP, Smith DH (2002) Intravascular coagulation: a major secondary insult in nonfatal traumatic brain injury. J Neurosurg 97:1373–1377PubMed
30.
go back to reference Longhi L, Valeriani V, Rossi S, De Marchi M, Egidi M, Stocchetti N (2002) Effects of hyperoxia on brain tissue oxygen tension in cerebral focal lesions. Acta Neurochir Suppl 81:315–317PubMed Longhi L, Valeriani V, Rossi S, De Marchi M, Egidi M, Stocchetti N (2002) Effects of hyperoxia on brain tissue oxygen tension in cerebral focal lesions. Acta Neurochir Suppl 81:315–317PubMed
31.
go back to reference Stocchetti N, Longhi L (2004) Moving from macro- to microcirculation in head injury. Crit Care Med 32:1429–1430PubMedCrossRef Stocchetti N, Longhi L (2004) Moving from macro- to microcirculation in head injury. Crit Care Med 32:1429–1430PubMedCrossRef
32.
go back to reference Thomale UW, Kroppenstedt SN, Beyer TF, Schaser KD, Unterberg AW, Stover JF (2002) Temporal profile of cortical perfusion and microcirculation after controlled cortical impact injury in rats. J Neurotrauma 19:403–413PubMedCrossRef Thomale UW, Kroppenstedt SN, Beyer TF, Schaser KD, Unterberg AW, Stover JF (2002) Temporal profile of cortical perfusion and microcirculation after controlled cortical impact injury in rats. J Neurotrauma 19:403–413PubMedCrossRef
33.
go back to reference Jaeger M, Soehle M, Schuhmann MU, Winkler D, Meixensberger J (2005) Correlation of continuously monitored regional cerebral blood flow and brain tissue oxygen. Acta Neurochir (Wien) 147:51–56CrossRef Jaeger M, Soehle M, Schuhmann MU, Winkler D, Meixensberger J (2005) Correlation of continuously monitored regional cerebral blood flow and brain tissue oxygen. Acta Neurochir (Wien) 147:51–56CrossRef
Metadata
Title
Monitoring brain tissue oxygen tension in brain-injured patients reveals hypoxic episodes in normal-appearing and in peri-focal tissue
Authors
Luca Longhi
Francesca Pagan
Valerio Valeriani
Sandra Magnoni
Elisa R. Zanier
Valeria Conte
Vincenzo Branca
Nino Stocchetti
Publication date
01-12-2007
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 12/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-007-0845-2

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