Correlation of noninvasive cerebral oximetry with cerebral perfusion in the severe head injured patient: a pilot study.
BACKGROUND
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in trauma patients. Cerebral perfusion pressure (CPP) directed ICU management is recommended for patients with severe TBI. It, however, requires an invasive device to measure intracranial pressure (ICP). Transcranial cerebral oximetry is a noninvasive method utilizing near-infrared technology to indirectly measure cerebral saturation (StCO2).


METHODS
A prospective observational study was performed at a Level I trauma center. Data were collected hourly for the first 6 days on four patients with severe TBI. Each patient had ICP monitoring and StCO2 (INVOS, Somanetics) assessed from each frontal lobe. CPP directed care was used.


RESULTS
Four patients with TBI, with admission GCS scores of 4, 4, 7, and 8, all had subdural hematomas and contusions; three had subarachnoid hemorrhage (SAH); one had an epidural hematoma (the only death; day 6); two had craniotomies. In the first 48 hours when CPP > or = 70, StCO2 was 71 +/- 9, while it was 61 +/- 9 when CPP < 70 (p < 0.0001). This relationship was constant for all study days, with p < 0.0001. Moreover, CPP < 70 correlated with StCO2 with r = 0.8l and r(2) = 0.66. StCO2 > or = 75 was associated with CPP > or = 70 96.4% of the time (95% CL, 94.3-98.5%). StCO2 < 55 was associated with CPP < 70 68.2% of the time (95% CL, 57-79.4%). Also, 13.4% of observations with CPP > or = 70 had StCO2 < 60, suggesting the potential of cerebral ischemia in the face of "normal" CPP. The StCO2 patches were user-friendly and not technically finicky.


CONCLUSIONS
In this pilot study, StCO2 correlated significantly with CPP. A StCO2 > or = 75 suggests that CPP is adequate, while < 55 suggests an inadequate CPP. Although these results should be confirmed in a larger study, StCO2 may serve as a noninvasive measurement of cerebral perfusion in the patient with a TBI or, at the very least, a sensitive indicator for the need to begin monitoring the ICP.
Dunham
C Michael
CM
St. Elizabeth Health Center, Youngstown, Ohio 44501, USA. michael_dunham@hmis.org
Sosnowski
Cheryl
C
Porter
John M
JM
Siegal
Joel
J
Kohli
Chander
C
D000328:Adult; D001785:Blood Gas Monitoring, Transcutaneous; D001930:Brain Injuries / Q000097:blood* / Q000150:complications / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D006408:Hematoma, Subdural / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D014193:Trauma Centers