title: Brain Tissue Oxygen Monitoring and the Intersection of Brain and Lung: A Comprehensive Review.
abstract: Traumatic brain injury is a problem that affects millions of Americans yearly and for which there is no definitive treatment that improves outcome. Continuous brain tissue oxygen (PbtO2 ) monitoring is a complement to traditional brain monitoring techniques, such as intracranial pressure and cerebral perfusion pressure. PbtO2 monitoring has not yet become a clinical standard of care, due to several unresolved questions. In this review, we discuss the rationale and technology of PbtO2 monitoring. We review the literature, both historic and current, and show that continuous PbtO2 monitoring is feasible and useful in patient management. PbtO2 numbers reflect cerebral blood flow and oxygen diffusion. Thus, continuous monitoring of PbtO2 yields important information about both the brain and the lung. The preclinical and clinical studies demonstrating these findings are discussed. In this review, we demonstrate that patient management in a PbtO2 -directed fashion is not the sole answer to the problem of treating traumatic brain injury but is an important adjunct to the armamentarium of multimodal neuromonitoring.
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, San Francisco General Hospital, and the Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California 94110.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Ngwenya
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, San Francisco General Hospital, and the Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California 94110.
authors.forename: John F
authors.initials: JF
authors.lastname: Burke
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, San Francisco General Hospital, and the Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California 94110. manleyg@ucsf.edu.
authors.forename: Geoffrey T
authors.initials: GT
authors.lastname: Manley
mesh_terms: D000818:Animals; D001921:Brain / Q000503:physiopathology*; D000070642:Brain Injuries, Traumatic / Q000503:physiopathology* / Q000628:therapy; D002245:Carbon Dioxide / Q000378:metabolism; D006801:Humans; D006985:Hyperventilation / Q000503:physiopathology; D007427:Intracranial Pressure; D008168:Lung / Q000503:physiopathology*; D008991:Monitoring, Physiologic / Q000379:methods; D010100:Oxygen / Q000378:metabolism*; D010313:Partial Pressure
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen
keywords: Licox; brain tissue oxygenation; cerebral blood flow; cerebral pressure autoregulation; neurovent; oxygen reactivity; traumatic brain injury