title: The new Licox combined brain tissue oxygen and brain temperature monitor: assessment of in vitro accuracy and clinical experience in severe traumatic brain injury.
abstract: OBJECTIVE
  Monitoring of brain tissue oxygen tension is increasingly being used to monitor patients after severe traumatic brain injury and to guide therapies aimed at maintaining brain tissue oxygen tension above threshold levels. The new Licox PMO combined oxygen and temperature catheter (Integra LifeSciences, Plainsboro, NJ) combines measurements of oxygen tension and temperature in a single probe inserted through a bolt mechanism. In this study, we sought to evaluate the accuracy of the new Licox PMO probe under controlled laboratory conditions and to assess the accuracy of oxygen tension and temperature measurements and the new automated card calibration system. We also describe our clinical experience with the Licox PMO probe.
  
  
  METHODS
  Oxygen tension was measured in a 2-chambered apparatus at different oxygen tensions and temperatures. The new card calibration system was compared with a manually calibrated system. Rates of hematoma, infection, and dislodgement in our clinical experience were recorded.
  
  
  RESULTS
  The new Licox PMO probe accurately measures oxygen tension over a wide range of oxygen concentrations and physiological temperatures, but it does have a small tendency to underestimate oxygen tension (mean error, -3.8 +/- 3.5%) that is more pronounced between the temperatures of 33 and 39 degrees C. The thermistor of the PMO probe also has a tendency to underestimate temperature when compared with a resistance thermometer (mean error, -0.67 +/- 0.22 degrees C). The card calibration system was also found to introduce some variability in measurements of oxygen tension when compared with a manually calibrated system. Clinical experience with the new probe indicates good placement within the white matter using the improved bolt system and low rates of hematoma (2.9%), infection (0%), and dislodgement (5.9%).
  
  
  CONCLUSIONS
  The new Licox PMO probe is accurate but has a small, consistent tendency to under-read oxygen tension that is more pronounced at higher temperatures. The probe tends to under-read temperature by 0.5 to 0.8 degrees C across temperatures, suggesting that caution should be used when brain temperature is measured with the Licox PMO probe and used to guide temperature-directed treatment strategies. The Licox PMO probe improves upon previous models in allowing consistent and accurate placement in the white matter and obviating the need for placement of 2 separate probes to measure oxygen tension and temperature.
authors.affiliation: Department of Surgery, San Francisco General Hospital, University of California, San Francisco, San Francisco, California 94110, USA.
authors.forename: Campbell
authors.initials: C
authors.lastname: Stewart
authors.forename: Iain
authors.initials: I
authors.lastname: Haitsma
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Zador
authors.forename: J Claude
authors.initials: JC
authors.lastname: Hemphill
authors.forename: Diane
authors.initials: D
authors.lastname: Morabito
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Manley
authors.forename: Guy
authors.initials: G
authors.lastname: Rosenthal
mesh_terms: D001831:Body Temperature; D001930:Brain Injuries / Q000175:diagnosis / Q000503:physiopathology*; D002404:Catheterization; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D010092:Oximetry / Q000295:instrumentation* / Q000379:methods; D010100:Oxygen / Q000032:analysis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013673:Technology Assessment, Biomedical; D013817:Thermography / Q000295:instrumentation* / Q000379:methods; D014159:Transducers
chemical_list: D010100:Oxygen