[Recent advances in regional cerebral monitoring in the neurocritical patient: brain tissue oxygen pressure monitoring, cerebral microdialysis and near-infrared spectroscopy].
The long term outcome of head-injured patients depends not only on the primary brain lesions but also to a large extent on the secondary lesions. The diagnosis of many secondary lesions, and specially that of brain ischemia, is based on simultaneous monitoring of several intracranial and systemic variables. Continuous intracranial pressure (ICP) monitoring is currently considered indispensable in the management of all patients with a severe head injury and intracranial lesions. However, the information provided by this technique is insufficient to diagnose some of the complex physiopathological processes that characterize traumatic brain lesions. Consequently, the use of methods to estimate cerebral blood flow such as transcranial Doppler and jugular oximetry to complement ICP monitoring is becoming increasingly widespread. Nevertheless, determining the effect of tissue lesions and therapeutic measures on cerebral metabolism currently requires direct access to the brain parenchyma at the bedside. In this review we focus on three methods of regional cerebral monitoring: oxygen tissue pressure (PtiO(2)) monitoring, microdialysis and near-infrared spectroscopy. The bases of each method and reference values for the variables analyzed will be discussed. We also make a series of recommendations on how results should be interpreted in light of current knowledge.
Poca
M A
MA
Servicio de Neurocirugia, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona.
Sahuquillo
J
J
Mena
M P
MP
Vilalta
A
A
Riveiro
M
M
D001921:Brain / Q000378:metabolism / Q000473:pathology; D001923:Brain Chemistry; D020520:Brain Infarction / Q000175:diagnosis / Q000378:metabolism; D001930:Brain Injuries / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D003422:Critical Care / Q000379:methods; D003937:Diagnosis, Differential; D005990:Glycerol / Q000737:chemistry; D006801:Humans; D007427:Intracranial Pressure; D017551:Microdialysis / Q000295:instrumentation / Q000379:methods; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D010092:Oximetry / Q000295:instrumentation / Q000379:methods; D010100:Oxygen / Q000378:metabolism; D011237:Predictive Value of Tests; D012016:Reference Values; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity; D013055:Spectrophotometry, Infrared
D005990:Glycerol; D010100:Oxygen