title: Continuous brain tissue oxygenation monitoring in the management of pediatric stroke.
abstract: BACKGROUND
  Direct invasive monitoring of brain tissue oxygenation (PbtO(2)) has been routinely utilized to predict cerebral ischemia and to prevent secondary injury in patients with traumatic brain injury (TBI) and vasospasm secondary to subarachnoid hemorrhage (SAH). The safety and utility of these devices in the pediatric population have been examined in a few small studies. No studies, however, have examined the use of PbtO(2) monitoring in stroke patients.
  
  
  METHODS
  Retrospective chart review of the first two consecutive, critically ill pediatric patients in the pediatric intensive care unit requiring brain tissue oxygen monitoring for newly diagnosed cerebral ischemia. ICP, CPP, PbtO(2), SaO(2), BP, and RR were all continually monitored during their care and were retrospectively collected and reviewed.
  
  
  RESULTS
  We present two pediatric stroke patients managed in a critical care setting with PbtO(2) monitoring in addition to ICP, MAP, CPP, and SaO(2).  Both patients had multiple events of low brain tissue oxygen (PbtO(2) <20 torr), independent of abnormal values in other monitoring parameters, which required physician intervention.  No new ischemic damage occurred after PbtO(2) monitoring began in either patient.
  
  
  CONCLUSIONS
  There is currently inadequate data to support the application of PbtO(2) monitoring in children with stroke to prevent progressive ischemia and to improve outcome. However, the positive results for these two patients support the need for further study in this area.
authors.affiliation: Division of Child Neurology, Department of Pediatrics, Weill Cornell Medical College, New York 10065, USA.
authors.forename: Baxter B
authors.initials: BB
authors.lastname: Allen
authors.forename: Caitlin E
authors.initials: CE
authors.lastname: Hoffman
authors.forename: Chani S
authors.initials: CS
authors.lastname: Traube
authors.forename: Steven L
authors.initials: SL
authors.lastname: Weinstein
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Greenfield
mesh_terms: D000063:Accidents, Traffic; D001794:Blood Pressure / Q000502:physiology; D001921:Brain / Q000098:blood supply*; D002545:Brain Ischemia / Q000097:blood / Q000175:diagnosis*; D001932:Brain Neoplasms / Q000097:blood / Q000175:diagnosis; D020215:Carotid Artery, Internal, Dissection / Q000097:blood / Q000175:diagnosis; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D015600:Glasgow Coma Scale; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D020244:Infarction, Middle Cerebral Artery / Q000097:blood / Q000175:diagnosis; D015278:Intensive Care Units, Pediatric; D020766:Intracranial Embolism / Q000097:blood / Q000175:diagnosis; D007427:Intracranial Pressure / Q000502:physiology; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D009447:Neuroblastoma / Q000097:blood / Q000175:diagnosis; D010100:Oxygen / Q000032:analysis*; D012189:Retrospective Studies; D012851:Sinus Thrombosis, Intracranial / Q000097:blood / Q000175:diagnosis; D019291:Skull Base / Q000293:injuries; D012887:Skull Fractures / Q000097:blood / Q000175:diagnosis; D020521:Stroke / Q000097:blood / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed
chemical_list: D010100:Oxygen