title: Cerebral oxygenation monitoring.
abstract: OBJECTIVE
  To discuss theoretical and practical aspects of cerebral oxygenation, from isolated observational measurements to continuous interventional monitoring.
  
  
  METHODS
  Relevant articles from the pertinent literature, as well as a multivariate physiologic diagram developed in this article.
  
  
  METHODS
  Theoretical, experimental, and clinical information that further clarifies the physiologic relevance of cerebral oxygenation.
  
  
  METHODS
  All basic concepts of cerebral hemometabolism were used, up to cerebral hemodynamic reserve, and were interrelated accordingly.
  
  
  RESULTS
  Cerebral perfusion pressure alone does not allow global cerebral hemometabolic optimization. The same situation is true for cerebral blood flow. The reason for this limitation is because these variables lack metabolic information. Cerebral arteriovenous differences do allow global cerebral hemometabolic optimization, because they reflect the exchange between the capillary and the tissue. In addition, cerebral hemodynamic reserve allows quantification of the cerebral microcirculatory tolerance to increases in intracranial "tightness" (decreases in intracranial compliance).
  
  
  CONCLUSIONS
  Multivariate optimization of global cerebral oxygenation, primarily based on global cerebral oxygen delivery and extraction, may strongly affect outcome in a variety of predominantly diffuse, acute intracranial disorders. Cerebral hemodynamic reserve may be further explored in experimental and clinical areas, involving not just acute brain trauma.
authors.affiliation: Division of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia.
authors.forename: J
authors.initials: J
authors.lastname: Cruz
authors.forename: E C
authors.initials: EC
authors.lastname: Raps
authors.forename: O J
authors.initials: OJ
authors.lastname: Hoffstad
authors.forename: J L
authors.initials: JL
authors.lastname: Jaggi
authors.forename: T A
authors.initials: TA
authors.lastname: Gennarelli
mesh_terms: D001783:Blood Flow Velocity; D001784:Blood Gas Analysis; D001927:Brain Diseases / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology*; D001930:Brain Injuries / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D003187:Compliance; D006439:Hemodynamics; D006801:Humans; D007427:Intracranial Pressure; D008833:Microcirculation; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D010092:Oximetry; D010101:Oxygen Consumption; D010108:Oxyhemoglobins / Q000032:analysis; D013055:Spectrophotometry, Infrared; D014655:Vascular Resistance
chemical_list: D010108:Oxyhemoglobins