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Intensive Care Medicine
Published in: Intensive Care Medicine 8/2010

01-08-2010 | Original

Invasive and noninvasive assessment of cerebral oxygenation in patients with severe traumatic brain injury

Authors: Santiago R. Leal-Noval, Aurelio Cayuela, Victoria Arellano-Orden, Antonio Marín-Caballos, Vicente Padilla, Carmen Ferrándiz-Millón, Yael Corcia, Claudio García-Alfaro, Rosario Amaya-Villar, Francisco Murillo-Cabezas

Published in: Intensive Care Medicine | Issue 8/2010

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Abstract

Purpose

The aim of this study is to investigate the relationship between invasive brain tissue oxygen pressure (PbrO2) and noninvasive regional transcranial oxygen saturation (rSO2) in 22 stable patients with severe traumatic brain injury (TBI) during a 16 h period.

Methods

This was a prospective, observational study carried out in the Neurocritical Care Unit of a level 1 trauma center in a teaching hospital. A total of 41,809 paired records for neuromonitoring variables were analyzed and compared.

Results

A direct and independent correlation between rSO2 and PbrO2 was confirmed through adjusted [β coefficient and (95% confidence interval, CI) = 0.36 (0.35–0.37)] and logistic [PbrO2 ≥15 mmHg, as a dependent variable; adjusted odds ratio (AOR) and (95% CI) = 1.11 (1.10–1.12)] regression analyses. A receiver-operating characteristic (ROC) curve demonstrated that rSO2 had low accuracy for detecting moderate (PbrO2 ≤15 mmHg) intracerebral hypoxia [area under curve (AUC) = 0.62], with the likelihood ratio for a positive test (LR+) = 1.2 for an optimal cutoff of rSO2 ≤70%. In contrast, the ROC analysis showed that rSO2 was moderately accurate for detecting severe (PbrO2 ≤12 mmHg) intracerebral hypoxemia (AUC = 0.82; LR+ = 5.3) for an optimal cutoff of rSO2 ≤60%.

Conclusions

In patients with severe TBI, PbrO2 and rSO2 were directly and significantly related. Severe intracerebral hypoxia was better detected by rSO2 than was moderate intracerebral hypoxia. However, the diagnostic accuracy of rSO2 was limited, and this measure should not be considered a substitute for routine PbrO2 monitoring.
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Metadata
Title
Invasive and noninvasive assessment of cerebral oxygenation in patients with severe traumatic brain injury
Authors
Santiago R. Leal-Noval
Aurelio Cayuela
Victoria Arellano-Orden
Antonio Marín-Caballos
Vicente Padilla
Carmen Ferrándiz-Millón
Yael Corcia
Claudio García-Alfaro
Rosario Amaya-Villar
Francisco Murillo-Cabezas
Publication date
01-08-2010
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 8/2010
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-010-1920-7

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