nach oben

Erschienen in:

01.08.2010 | Original

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

verfasst von: 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

Erschienen in: Intensive Care Medicine | Ausgabe 8/2010

Einloggen, um Zugang zu erhalten

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.

Andrews PJ, Citerio G, Longhi L, Polderman K, Sahuquillo J, Vajkoczy P, Neuro-Intensive Care and Emergency Medicine (NICEM), Section of the European Society of Intensive Care Medicine (2008) NICEM consensus on neurological monitoring in acute neurological disease. Intensive Care Med 34:1362–1370CrossRefPubMed

Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, Manley GT, Nemecek A, Newell DW, Rosenthal G, Schouten J, Shutter L, Timmons SD, Ullman JS, Videtta W, Wilberger JE, Wright DW (2007) Guidelines for the management of severe traumatic brain injury. X. Brain oxygen monitoring and thresholds. J Neurotrauma 24(supp 1):S65–S70PubMed

Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, Manley GT, Nemecek A, Newell DW, Rosenthal G, Schouten J, Shutter L, Timmons SD, Ullman JS, Videtta W, Wilberger JE, Wright DW (2007) Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma 24(supp 1):S37–S44PubMed

Gracias VH, Guillamondegui OD, Stiefel MF, Wilensky EM, Bloom S, Gupta R, Pryor JP, Reilly PM, Leroux PD, Schwab CW (2004) Cerebral cortical oxygenation: a pilot study. J Trauma 56:469–474CrossRefPubMed

Yao FS, Tseng CC, Ho CY, Levin SK, Illner P (2004) Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 18:552–558CrossRefPubMed

Tobias JD (2006) Cerebral oxygenation monitoring: near-infrared spectroscopy. Expert Rev Med Dev 3:235–243CrossRef

Yoshitani K, Kawaguchi M, Miura N, Okuno T, Kanoda T, Ohnishi Y, Kuro M (2007) Effects of hemoglobin concentration, skull thickness, and the area of the cerebrospinal fluid layer on NIRS measurements. Anesthesiology 106:458–462CrossRefPubMed

Lewis SB, Myburgh JA, Thornton EL, Reilly PL (1996) Cerebral oxygenation monitoring by NIRS is not clinically useful in patients with severe closed-head injury: a comparison with jugular venous bulb oximetry. Crit Care Med 24:1334–1338CrossRefPubMed

McLeod AD, Igielman F, Elwell C, Cope M, Smith M (2003) Measuring cerebral oxygenation during normobaric hyperoxia: a comparison of tissue microprobes, NIRS, and jugular venous oximetry in head injury. Anesth Analg 97:851–856CrossRefPubMed

10.

Dunham CM, Ransom KJ, Flowers LL, Siegal JD, Kohli CM (2004) Cerebral hypoxia in severely brain injured patients is associated with admission Glasgow Coma Scale Score, computed tomographic severity, cerebral perfusion pressure, and survival. J Trauma 56:482–491CrossRefPubMed

11.

Rothoerl RD, Faltermeier R, Burger R, Woertgen C, Brawanski A (2002) Dynamic correlation between tissue PO2 and near infrared spectroscopy. Acta Neurochir Suppl 81:311–313

12.

Brawanski A, Faltermeier R, Rothoerl RD, Woertgen C (2002) Comparison of near-infrared spectroscopy and tissue PO2 time series in patients after severe head injury and aneurismal subarachnoid hemorrhage. J Cereb Blood Flow Metab 22:605–611CrossRefPubMed

13.

Marín-Caballos AJ, Murillo-Cabezas F, Cayuela-Domínguez A, Domínguez-Roldán JM, Rincón-Ferrari MD, Valencia-Anguita J, Flores-Cordero JM, Muñoz-Sánchez MA (2005) Cerebral perfusion pressure and risk of brain hypoxia in severe head injury: a prospective observational study. Crit Care 9:R670–R676CrossRefPubMed

14.

Marín-Caballos AJ, Murillo-Cabezas F, Domínguez-Roldan JM, Leal-Noval SR, Rincón-Ferrari MD, Muñoz-Sánchez MA (2008) Monitoring of tissue oxygen pressure (PtiO2) in cerebral hypoxia: diagnostic and therapeutic approach. Med Intensiva 32:81–90CrossRefPubMed

15.

Akobeng AK (2006) Understanding diagnostic tests 2: likelihood ratios, pre- and post-test probabilities and their use in clinical practice. Acta Paediatry 96:487–491CrossRef

16.

Fisher JE, Bachman LM, Jaeschke R (2003) A readers’ guide to the interpretation of diagnostic test properties: clinical example of sepsis. Intensive Care Med 29:1043–1051CrossRef

17.

Cruz J (1998) The first decade of continuous monitoring of jugular bulb oxyhemoglobin saturation: management strategies and clinical outcome. Crit Care Med 26:344–351CrossRefPubMed

18.

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 46:868–878CrossRefPubMed

19.

Valadka AB, Gopinath SP, Contant CF, Uzura M, Robertson CS (1998) Relatioship of brain tissue PO₂ to outcome after severe head injury. Crit Care Med 26:1576–1581CrossRefPubMed

20.

Stiefel MF, Spiotta A, Gracias VH, Garuffe AM, Guillamondegui O, Maloney-Wilensky E, Bloom S, Grady MS, Le Roux PD (2005) Reduced mortality in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg 103:805–811CrossRefPubMed

21.

Narotam PK, Morrison JF, Nathoo N (2009) Brain tissue monitoring in traumatic brain injury and major trauma: outcome analysis of a brain tissue oxygen-directed therapy. J Neurosurg 111:672–682CrossRefPubMed

22.

Longhi L, Pagan F, Valeriani V, Magnoni S, Zanier ER, Conte V, Branca V, Stocchetti N (2007) Monitoring brain tissue oxygen tension in brain-injured patients reveals hypoxic episodes in normal-appearing and in peri-focal tissue. Intensive Care Med 33:2136–2142CrossRefPubMed

23.

Rose JC, Neill TA, Hemphill JC (2006) Continuous monitoring of the microcirculation in neurocritical care: an update of brain tissue oxygenation. Curr Opin Crit Care 12:97–102CrossRefPubMed

24.

Rosenthal G, Hemphill JC III, Sorani M, Martin C, Morabito D, Obrist WD, Manley GT (2008) Brain tissue tension is more indicative of oxygen diffusion than oxygen delivery and metabolism in patients with traumatic brain injury. Crit Care Med 36:1917–1924CrossRefPubMed

25.

Leal-Noval SR, Rincón-Ferrari MD, Marin-Niebla A, Cayuela A, Arellano-Orden V, Marín-Caballos A, Amaya-Villar R, Ferrándiz-Millón C, Murillo-Cabeza F (2006) Transfusion of erythrocyte concentrates produces a variable increment on cerebral oxygenation in patients with severe traumatic brain injury: a preliminary study. Intensive Care Med 32:1733–1740CrossRefPubMed

26.

Smith M, Elwell C (2009) Near-infrared spectroscopy: shedding light on the injured brain. Anesth Analg 108:1055–1057CrossRefPubMed

27.

Watzman HM, Kurth CD, Montenegro LM, Rome J, Steven JM, Nicolson SC (2000) Arterial and venous contributions to near-infrared cerebral oximetry. Anesthesiology 93:947–953CrossRefPubMed

28.

Shah N, Trivedi NK, Clack SL, Shah M, Shah PP, Barker S (2000) Impact of hypoxemia on the performance of cerebral oximeter in volunteer subjects. J Neurosurg Anesthesiol 12:201–209CrossRefPubMed

29.

Stoneham MD, Lodi O, de Beer TC, Sear JW (2008) Increased oxygen administration improves cerebral oxygenation in patients undergoing awake carotid surgery. Anesth Analg 107:1670–1675CrossRefPubMed

30.

Naidech AM, Bendok BR, Ault ML, Bleck TP (2008) Monitoring with the Somanetics INVOS 5100C after aneurysmal subarachnoid hemorrhage. Neurocrit Care 9:326–331CrossRefPubMed

31.

Skhirtladze K, Birkenberg B, Mora B, Moritz A, Ince I, Ankersmit HJ, Steinlechner B, Dworschak M (2009) Cerebral desaturation during cardiac arrest: its relation to arrest duration and left ventricular pump function. Crit Care Med 37:471–475CrossRefPubMed

32.

Matsumoto S, Nakahara I, Higashi T, Iwamuro Y, Watanabe Y, Takahashi K, Ando M, Takezawa M, Kira JI (2009) Near-infrared spectroscopy in carotid artery stenting predicts cerebral hyperperfusion syndrome. Neurology 28:1512–1518CrossRef

33.

Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Danelli G, Fierro G, De Cosmo G, Servillo G (2005) Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth Analg 101:740–747CrossRefPubMed

34.

Brady KM, Lee JK, Kibler KK, Smielewski P, Czosnyka M, Easley RB, Koehler RC, Shaffner DH (2007) Continuous time–domain analysis of cerebrovascular autoregulation using near-infrared spectroscopy. Stroke 38:2818–2825CrossRefPubMed

35.

Steiner LA, Pfister D, Strebel SP, Radolovich D, Smielewski P, Czosnyka M (2009) Near-infrared spectroscopy can monitor dynamic cerebral autoregulation in adults. Neurocrit Care 10:122–128CrossRefPubMed

36.

Nagdyman N, Ewert P, Peters B, Miera O, Fleck T, Berger F (2008) Comparison of different near-infrared spectroscopy cerebral oxygenation indices with central venous and jugular venous oxygenation saturation in children. Paediatric Anaesth 18:160–166

37.

Tobias JD (2008) Cerebral oximetry monitoring with near infrared spectroscopy detects alterations in oxygenation before pulse oximetry. J Intensive Care Med 23:384–388CrossRefPubMed

38.

Kahraman S, Kayali H, Atabey C, Acar F, Gocmen S (2006) The accuracy of near-infrared spectroscopy in detection of subdural and epidural hematomas. J Trauma 61:1480–1483CrossRefPubMed

39.

Büchner K, Meixensberger J, Dings J, Roosen K (2000) Near-infrared spectroscopy not useful to monitor cerebral oxygenation after severe brain injury. Zentralbl Neurochir 61:69–73CrossRefPubMed

40.

Marcin JP (2007) Size matters to a model’s fit. Crit Care Med 35:2212–2213CrossRefPubMed

Titel: Invasive and noninvasive assessment of cerebral oxygenation in patients with severe traumatic brain injury
verfasst von: 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
Publikationsdatum: 01.08.2010
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 8/2010
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-010-1920-7

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

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