Cerebral Cortical Oxygenation

A Pilot Study

Vicente H. Gracias, Oscar D. Guillamondegui, Michael F. Stiefel, Eileen M. Wilensky, Stephanie Bloom, Rajan Gupta, John P. Pryor, Patrick M. Reilly, Peter D. Leroux, C. William Schwab, William Mileski, Vernon J. Henderson, Samir M. Fakhry, Alex B. Valadka

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Cerebral hypoxia (cerebral cortical oxygenation [PbrO 2] < 20 mm Hg) monitored by direct measurement has been shown in animal and small clinical studies to be associated with poor outcome. We present our preliminary results observing PbrO2 in patients with traumatic brain injury (TBI). Methods: A prospective observational cohort study was performed. Institutional review board approval was obtained. All patients with TBI who required measurement of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and PbrO2 because of a Glasgow Coma Scale score < 8 were enrolled. Data sets (ICP, CPP, PbrO2, positive end-expiratory pressure (PEEP), PaO2, and PacO2) were recorded during routine manipulation. Episodes of cerebral hypoxia were compared with episodes without. Results are displayed as mean ± SEM; t test, χ2, and Fisher's exact test were used to answer questions of interest. Results: One hundred eighty-one data sets were abstracted from 20 patients. Thirty-five episodes of regional cerebral hypoxia were identified in 14 patients. Compared with episodes of acceptable cerebral oxygenation, episodes of cerebral hypoxia were noted to be associated with a significantly lower mean PaO2 (144 ± 14 vs. 165 ± 8; p < 0.01) and higher mean PEEP (8.8 ± 0.7 vs. 7.1 ± 0.3; p < 0.01). Mean ICP and CPP measurements were similar between groups. In a univariate analysis, cerebral hypoxic episodes were associated with PaO2 ≤ 100 mm Hg (p < 0.01) and PEEP > 5 cm H2O (p < 0.01), but not ICP > 20 mm Hg, CPP ≤ 65 mm Hg, or PacO2 ≤ 35 mm Hg. Conclusion: Cerebral oxymetry is confirmed safe in the patient with multiple injuries with TBI. Occult cerebral hypoxia is present in the traumatic brain injured patient despite normal traditional measurements of cerebral perfusion. Further research is necessary to determine whether management protocols aimed at the prevention of cerebral cortical hypoxia will affect outcome.

Original languageEnglish (US)
Pages (from-to)469-474
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume56
Issue number3
StatePublished - Mar 2004
Externally publishedYes

Fingerprint

Brain Hypoxia
Multiple Trauma
Perfusion
Brain
Research

Keywords

  • Brain tissue oxygenation
  • Cerebral hypoxia
  • Cerebral perfusion pressure
  • Intracranial pressure
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery

Cite this

Gracias, V. H., Guillamondegui, O. D., Stiefel, M. F., Wilensky, E. M., Bloom, S., Gupta, R., ... Valadka, A. B. (2004). Cerebral Cortical Oxygenation: A Pilot Study. Journal of Trauma - Injury, Infection and Critical Care, 56(3), 469-474.

Cerebral Cortical Oxygenation : A Pilot Study. / Gracias, Vicente H.; Guillamondegui, Oscar D.; Stiefel, Michael F.; Wilensky, Eileen M.; Bloom, Stephanie; Gupta, Rajan; Pryor, John P.; Reilly, Patrick M.; Leroux, Peter D.; Schwab, C. William; Mileski, William; Henderson, Vernon J.; Fakhry, Samir M.; Valadka, Alex B.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 56, No. 3, 03.2004, p. 469-474.

Research output: Contribution to journalArticle

Gracias, VH, Guillamondegui, OD, Stiefel, MF, Wilensky, EM, Bloom, S, Gupta, R, Pryor, JP, Reilly, PM, Leroux, PD, Schwab, CW, Mileski, W, Henderson, VJ, Fakhry, SM & Valadka, AB 2004, 'Cerebral Cortical Oxygenation: A Pilot Study', Journal of Trauma - Injury, Infection and Critical Care, vol. 56, no. 3, pp. 469-474.
Gracias VH, Guillamondegui OD, Stiefel MF, Wilensky EM, Bloom S, Gupta R et al. Cerebral Cortical Oxygenation: A Pilot Study. Journal of Trauma - Injury, Infection and Critical Care. 2004 Mar;56(3):469-474.
Gracias, Vicente H. ; Guillamondegui, Oscar D. ; Stiefel, Michael F. ; Wilensky, Eileen M. ; Bloom, Stephanie ; Gupta, Rajan ; Pryor, John P. ; Reilly, Patrick M. ; Leroux, Peter D. ; Schwab, C. William ; Mileski, William ; Henderson, Vernon J. ; Fakhry, Samir M. ; Valadka, Alex B. / Cerebral Cortical Oxygenation : A Pilot Study. In: Journal of Trauma - Injury, Infection and Critical Care. 2004 ; Vol. 56, No. 3. pp. 469-474.
@article{eab6335ee39c4365ab9dd04a88ecd889,
title = "Cerebral Cortical Oxygenation: A Pilot Study",
abstract = "Background: Cerebral hypoxia (cerebral cortical oxygenation [PbrO 2] < 20 mm Hg) monitored by direct measurement has been shown in animal and small clinical studies to be associated with poor outcome. We present our preliminary results observing PbrO2 in patients with traumatic brain injury (TBI). Methods: A prospective observational cohort study was performed. Institutional review board approval was obtained. All patients with TBI who required measurement of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and PbrO2 because of a Glasgow Coma Scale score < 8 were enrolled. Data sets (ICP, CPP, PbrO2, positive end-expiratory pressure (PEEP), PaO2, and PacO2) were recorded during routine manipulation. Episodes of cerebral hypoxia were compared with episodes without. Results are displayed as mean ± SEM; t test, χ2, and Fisher's exact test were used to answer questions of interest. Results: One hundred eighty-one data sets were abstracted from 20 patients. Thirty-five episodes of regional cerebral hypoxia were identified in 14 patients. Compared with episodes of acceptable cerebral oxygenation, episodes of cerebral hypoxia were noted to be associated with a significantly lower mean PaO2 (144 ± 14 vs. 165 ± 8; p < 0.01) and higher mean PEEP (8.8 ± 0.7 vs. 7.1 ± 0.3; p < 0.01). Mean ICP and CPP measurements were similar between groups. In a univariate analysis, cerebral hypoxic episodes were associated with PaO2 ≤ 100 mm Hg (p < 0.01) and PEEP > 5 cm H2O (p < 0.01), but not ICP > 20 mm Hg, CPP ≤ 65 mm Hg, or PacO2 ≤ 35 mm Hg. Conclusion: Cerebral oxymetry is confirmed safe in the patient with multiple injuries with TBI. Occult cerebral hypoxia is present in the traumatic brain injured patient despite normal traditional measurements of cerebral perfusion. Further research is necessary to determine whether management protocols aimed at the prevention of cerebral cortical hypoxia will affect outcome.",
keywords = "Brain tissue oxygenation, Cerebral hypoxia, Cerebral perfusion pressure, Intracranial pressure, Traumatic brain injury",
author = "Gracias, {Vicente H.} and Guillamondegui, {Oscar D.} and Stiefel, {Michael F.} and Wilensky, {Eileen M.} and Stephanie Bloom and Rajan Gupta and Pryor, {John P.} and Reilly, {Patrick M.} and Leroux, {Peter D.} and Schwab, {C. William} and William Mileski and Henderson, {Vernon J.} and Fakhry, {Samir M.} and Valadka, {Alex B.}",
year = "2004",
month = "3",
language = "English (US)",
volume = "56",
pages = "469--474",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Cerebral Cortical Oxygenation

T2 - A Pilot Study

AU - Gracias, Vicente H.

AU - Guillamondegui, Oscar D.

AU - Stiefel, Michael F.

AU - Wilensky, Eileen M.

AU - Bloom, Stephanie

AU - Gupta, Rajan

AU - Pryor, John P.

AU - Reilly, Patrick M.

AU - Leroux, Peter D.

AU - Schwab, C. William

AU - Mileski, William

AU - Henderson, Vernon J.

AU - Fakhry, Samir M.

AU - Valadka, Alex B.

PY - 2004/3

Y1 - 2004/3

N2 - Background: Cerebral hypoxia (cerebral cortical oxygenation [PbrO 2] < 20 mm Hg) monitored by direct measurement has been shown in animal and small clinical studies to be associated with poor outcome. We present our preliminary results observing PbrO2 in patients with traumatic brain injury (TBI). Methods: A prospective observational cohort study was performed. Institutional review board approval was obtained. All patients with TBI who required measurement of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and PbrO2 because of a Glasgow Coma Scale score < 8 were enrolled. Data sets (ICP, CPP, PbrO2, positive end-expiratory pressure (PEEP), PaO2, and PacO2) were recorded during routine manipulation. Episodes of cerebral hypoxia were compared with episodes without. Results are displayed as mean ± SEM; t test, χ2, and Fisher's exact test were used to answer questions of interest. Results: One hundred eighty-one data sets were abstracted from 20 patients. Thirty-five episodes of regional cerebral hypoxia were identified in 14 patients. Compared with episodes of acceptable cerebral oxygenation, episodes of cerebral hypoxia were noted to be associated with a significantly lower mean PaO2 (144 ± 14 vs. 165 ± 8; p < 0.01) and higher mean PEEP (8.8 ± 0.7 vs. 7.1 ± 0.3; p < 0.01). Mean ICP and CPP measurements were similar between groups. In a univariate analysis, cerebral hypoxic episodes were associated with PaO2 ≤ 100 mm Hg (p < 0.01) and PEEP > 5 cm H2O (p < 0.01), but not ICP > 20 mm Hg, CPP ≤ 65 mm Hg, or PacO2 ≤ 35 mm Hg. Conclusion: Cerebral oxymetry is confirmed safe in the patient with multiple injuries with TBI. Occult cerebral hypoxia is present in the traumatic brain injured patient despite normal traditional measurements of cerebral perfusion. Further research is necessary to determine whether management protocols aimed at the prevention of cerebral cortical hypoxia will affect outcome.

AB - Background: Cerebral hypoxia (cerebral cortical oxygenation [PbrO 2] < 20 mm Hg) monitored by direct measurement has been shown in animal and small clinical studies to be associated with poor outcome. We present our preliminary results observing PbrO2 in patients with traumatic brain injury (TBI). Methods: A prospective observational cohort study was performed. Institutional review board approval was obtained. All patients with TBI who required measurement of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and PbrO2 because of a Glasgow Coma Scale score < 8 were enrolled. Data sets (ICP, CPP, PbrO2, positive end-expiratory pressure (PEEP), PaO2, and PacO2) were recorded during routine manipulation. Episodes of cerebral hypoxia were compared with episodes without. Results are displayed as mean ± SEM; t test, χ2, and Fisher's exact test were used to answer questions of interest. Results: One hundred eighty-one data sets were abstracted from 20 patients. Thirty-five episodes of regional cerebral hypoxia were identified in 14 patients. Compared with episodes of acceptable cerebral oxygenation, episodes of cerebral hypoxia were noted to be associated with a significantly lower mean PaO2 (144 ± 14 vs. 165 ± 8; p < 0.01) and higher mean PEEP (8.8 ± 0.7 vs. 7.1 ± 0.3; p < 0.01). Mean ICP and CPP measurements were similar between groups. In a univariate analysis, cerebral hypoxic episodes were associated with PaO2 ≤ 100 mm Hg (p < 0.01) and PEEP > 5 cm H2O (p < 0.01), but not ICP > 20 mm Hg, CPP ≤ 65 mm Hg, or PacO2 ≤ 35 mm Hg. Conclusion: Cerebral oxymetry is confirmed safe in the patient with multiple injuries with TBI. Occult cerebral hypoxia is present in the traumatic brain injured patient despite normal traditional measurements of cerebral perfusion. Further research is necessary to determine whether management protocols aimed at the prevention of cerebral cortical hypoxia will affect outcome.

KW - Brain tissue oxygenation

KW - Cerebral hypoxia

KW - Cerebral perfusion pressure

KW - Intracranial pressure

KW - Traumatic brain injury

UR - http://www.scopus.com/inward/record.url?scp=11144356562&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=11144356562&partnerID=8YFLogxK

M3 - Article

VL - 56

SP - 469

EP - 474

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 3

ER -