Cerebral cortical oxygenation: a pilot study.
BACKGROUND
Cerebral hypoxia (cerebral cortical oxygenation [Pbro2] < 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, chi2, 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 < or = 100 mm Hg (p < 0.01) and PEEP > 5 cm H2O (p < 0.01), but not ICP > 20 mm Hg, CPP < or = 65 mm Hg, or Pac2 < or = 35 mm Hg.


CONCLUSIONS
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.
Gracias
Vicente H
VH
Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine, 3440 Market Street, First Floor, Philadelphia, PA 19104, USA. graciasv@uphs.upenn.edu
Guillamondegui
Oscar D
OD
Stiefel
Michael F
MF
Wilensky
Eileen M
EM
Bloom
Stephanie
S
Gupta
Rajan
R
Pryor
John P
JP
Reilly
Patrick M
PM
Leroux
Peter D
PD
Schwab
C William
CW
D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D001930:Brain Injuries / Q000503:physiopathology / Q000628:therapy*; D002545:Brain Ischemia / Q000175:diagnosis / Q000503:physiopathology; D002245:Carbon Dioxide / Q000097:blood; D002540:Cerebral Cortex / Q000098:blood supply*; D015331:Cohort Studies; D003422:Critical Care; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000175:diagnosis* / Q000503:physiopathology; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D010092:Oximetry / Q000295:instrumentation*; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000502:physiology; D010865:Pilot Projects; D011175:Positive-Pressure Respiration; D011379:Prognosis; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*; D013673:Technology Assessment, Biomedical; D014057:Tomography, X-Ray Computed
D002245:Carbon Dioxide; D010100:Oxygen