title: Monitoring of brain and systemic oxygenation in neurocritical care patients.
abstract: Maintenance of adequate oxygenation is a mainstay of intensive care, however, recommendations on the safety, accuracy, and the potential clinical utility of invasive and non-invasive tools to monitor brain and systemic oxygenation in neurocritical care are lacking. A literature search was conducted for English language articles describing bedside brain and systemic oxygen monitoring in neurocritical care patients from 1980 to August 2013. Imaging techniques e.g., PET are not considered. A total of 281 studies were included, the majority described patients with traumatic brain injury (TBI). All tools for oxygen monitoring are safe. Parenchymal brain oxygen (PbtO2) monitoring is accurate to detect brain hypoxia, and it is recommended to titrate individual targets of cerebral perfusion pressure (CPP), ventilator parameters (PaCO2, PaO2), and transfusion, and to manage intracranial hypertension, in combination with ICP monitoring. SjvO2 is less accurate than PbtO2. Given limited data, NIRS is not recommended at present for adult patients who require neurocritical care. Systemic monitoring of oxygen (PaO2, SaO2, SpO2) and CO2 (PaCO2, end-tidal CO2) is recommended in patients who require neurocritical care.
authors.affiliation: Department of Intensive Care Medicine, Faculty of Biology and Medicine, CHUV-Lausanne University Hospital, 1011, Lausanne, Switzerland, mauro.oddo@chuv.ch.
authors.forename: Mauro
authors.initials: M
authors.lastname: Oddo
authors.forename: Julian
authors.initials: J
authors.lastname: Bösel
mesh_terms: D001930:Brain Injuries / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D003422:Critical Care; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D064926:Neurophysiological Monitoring; D010092:Oximetry; D011379:Prognosis; D015203:Reproducibility of Results