Evaluation of changes in brain tissue oxygen levels (PbtO2) for detection of vasospasm in patients after subarachnoid haemorrhage


Authors: Ďuriš Kamil 1;  Smrčka Martin 1;  Ševčík Pavel 2;  Gál Roman 2;  Juráň Vilém 1;  Neuman Eduard 1;  Sova Marek 1;  Vybíhal Václav 1;  Kýr Michal 3
Authors‘ workplace: Neurochirurgická klinika LF MU a FN Brno 1;  Klinika anesteziologie, resuscitace a intenzivní medicíny LF MU a FN Brno 2;  Institut biostatistiky a analýz, Masarykova univerzita Brno 3
Published in: Anest. intenziv. Med., 20, 2009, č. 2, s. 102-106
Category: Intensive Care Medicine - Original Paper

Overview

Objective:
Evaluation of the impact of the admission clinical status of subarachnoid haemorrhage (SAH) patients (Hunt Hesse Score, HH3), the outcome (Glasgow Outcome Score, GOS) and the presence of vasospasm on the changes in the brain tissue oxygen levels (PbtO2), in relation to changes of FiO2 in mechanically ventilated patients.

Design:
Prospective interventional study.

Setting:
Neurosurgical Department of University Hospital, Department of Anaesthesia and Resuscitation, University Hospital.

Materials and methods:
We monitored PbtO2 in patients with SAH due to aneurysm rupture for 10 days. Presence of vasospasms was repeatedly assessed with transcranial doppler (TCD). In patients on mechanical ventilation we performed the clinical trial. We increased the FiO2 to 1.0 and measured the dynamics of changes of PbtO2 simultaneously. Thus we obtained 26 continual measurements in the study group of 7 patients. The influence of vasospasm, the admission HH3 and GOS on changes of PbtO2 after an increase of FiO2 were evaluated. Mixed models analyses were used to evaluate the measured data.

Results:
In the study group we observed a significant difference in the dynamics of PbtO2 levels after an increase of FiO2 in relation to the patients‘ admission clinical status (HH3), outcome (GOS) and the presence of vasospasm. The levels of PbtO2 after an increase in FiO2 increased more in the patients with the better clinical status (HH3) and better outcome (GOS) (p < 0.001 in both parameters). In patients without vasospasm we found a significantly higher increase of PbtO2 levels after increasing FiO2 than in patients with vasospasm (p < 0.001).

Conclusion:
The dynamics of PbtO2 levels were influenced by vasospasm. The changes of PbtO2 levels after increasing FiO2 are also associated with other factors (HH, GOS).

Keywords:
brain tissue oximetry – vasospasm – subarachnoid hemorrhage – aneurysm of brain vessels


Sources

1. Heros, R. C., Zervas, N. T., Varsos, V. Cerebral vasospasm after subarachnoid hemorrhage: an update. Ann. Neurol., 1983, 14, p. 599–608.

2. Kassell, N. F., Sasaki, T., Colohan, A. R. T., Nazar, G. Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke, 1985, 16, p. 562–572.

3. Thomas, J. E., Nemirovsky, A., Zelman, V., Giannotta, S. L. Rapid reversal of endothelin-1- induced cerebral vasoconstriction by intrathecal administration of nitric oxide donors. Neurosurgery, 1997, 40, p. 1245–1249.

4. Hossmann, K. A. Viability thresholds and the penumbra of focal ischemia. Ann. Neurol., 1994, 36, p. 557–565.

5. Stevens, W. J. Multimodal monitoring: Head injury management using SvjO2 and Licox. Journal of Neuroscience Nursing, 2004, 6, p. 332–339.

6. Meixensberger, J., Vath, A., Jaeger, M., Kunze, E., Dings, J., Roosen, K. Monitoring of brain tissue oxygenatioin following severe subarachnoid hemorrhage. Neurol. Res., 2003, 25, p. 445–450.

7. Nortje, J., Gupta, A. K. Tle role of tissue oxygen monitoring in patients with acute brain injury. British Journal of Anaesthesia, 2006, 97, p. 95–106.

8. Jaeger, M., Soehle, M., Meixensberger, J. Brain tissue oxygen (PtiO2): a clinical comparison of two monitoring devices. Acta Neurochir. Suppl., 2005, 95, p. 79–81.

9. Hoelper, B. M., Alessandri, B., Heimann, A., Behr, R., Kempski, O. Brain oxygen monitoring: in-vitro accuracy, long-term drift and response-time of Licox and Neurotrend sensors. Acta Neurochir., 2005, 147, p. 767–774.

10. Stiefel, M. F., Spiotta, A., Gracais, V. H., Garuffe, A. M., Guillamondegui, O., Maloney– Wilensky, E., Bloom, S., Grady, M. S., LeRoux, P. D. Reduced mortality rate in patients with severe traumatic brain injury treated with brain tisssue oxygen monitoring. J. Neurosurg., 2005, 103, p. 805–811.

11. Kiening, K. L., Unterberg, A. W., Bardt, T. F., Schneider, G. H., Lanksh, W. R. Monitoring of cerebral oxygenation in patients with severe head injuries: Brain tissue PO2 versus jugular vein oxygen saturation. J. Neurosurg., 1996, 85, p. 751–757.

12. Meixensberger, J., Baunach, S., Amschler, J., Dings, J., Roosen, K. Influence of body position on tissue PO2, cerebral perfusion pressure and intracranial pressure in pacients with acute brain injury. Neurol. Res., 1997, 19, p. 249–253.

13. Kett-White, R., Hutchinson, P. J., Al-Rawi, P. G., Gupta, A. K., Pickard, J. D., Kirkaptrick, P. J. Adverse cerebral events detected after subarachnoid hemorrhage using brain oxygen and microdialysis probes. Neurosurgery, 2002, 50, s. 1213–1222.

14. Meixensberger, J., Vath, A., Jaeger, M., Kunze, E., Dings, J., Roosen, K. Monitoring of brain tissue oxygenatioin following severe subarachnoid hemorrhage. Neurol. Res., 2003, 25, p. 445–450.

15. Kett-White, R., Hutchinson, P. J., Al-Rawi, P. G. et al. Cerebral oxygen and microdialysis monitoring during aneruysm surgery: eefects of blood pressure, cerebrospinal fluid dreinage and temporary clipping on infarction. J. Neurosurg., 2002, 96, p. 1013–1019.

16. Lang, E. W., Mulvey, J. M., Mudaliar, Y., Dorsch, N. W. Direct cerebral oxygenation monitoring- a systematic review of recent publications. Neurosurg. Rev., 2007, 30, p. 99–107.

17. Maas, A., Fleckenstein, W., de Jong, D., van. Santbrink, H. Monitoring cerebral oxygenation: experimental studies and preliminary clinical results of continuous monitoring of cerebrospinal fluid and brain tissuw oxygen tension. Acta Neurochir. Suppl., 1993, 59, p. 50–57.

18. Littlejohns, L. R., Bader, M. K., March, K. Brain Tissue Oxygen Monitoring in Severe Brain Injury, I Research and Usefulnass in Critical Care. Critical Care Nurse, 2003, 4, p. 17–25.

19. Valadka, A. B., Gopinatu, S. P., Contact, C. F., Uzura, M., Robertson, C. S. Relationships of brain tissue PO2 to outcome after severe head injury. Critical Care Medicine, 1998, 26, p. 1576–1581.

20. Náhlovský, J. et al. Neurochirurgie. 1. vyd. Praha: Galén a Nakladatelství Karolinum, 2006.

21. Fitzmaurice, G. M., Laure, N. M., Ware, J. H. Applied Longitudinal Analysis. 1. vyd. New Persey: Wiley paterscience, 2004.

22. Verbeke, G., Molenberghy, G. Linear Mixed Models for Longitudinal Data. 1.vyd. New York: Springer Verlag, 2000.

23. Meixensberger, J., Dings, J., Kuhning, H., Rossen, K. Studies of tissue PO2 in normal and pathological human brain cortex. Acta Neurochir. Suppl., 1993, 59, p. 58–63.

24. Dings, J., Meixensberger, J., Jager, A., Roosen, K. Clinical experience with 118 brain tissue oxygen partial pressure catheter probes. Neurosurgery, 1998, 43, p. 1082–1095.

25. McLeod, A. D., Igielman, F., Elwell, C., Cope, M., Smith, M. Measuring cerebral oxygenation during normobaric hyperoxia: a comparison of tissue microprobes, near- infrared spectroscopy, and jugular venous oxymetry in head injury. Anesth. Analg., 2003, 97, p. 851–856.

26. van Santbrink, H., Maas, A. L., Avezaat, C. J. Continuous monitoring of partial pressure of brain tissue oxygenation in patients with severe head injury. Neurosurgery, 1996, 38, p. 21–31.

27. van den Brink, W. A., van Santbrink, H., Steyerberg, E. W. et al. Brain oxygen tension in severe head injury. Neurosurgery, 2000, 46, p. 868–878.

28. Sedlak, P., Bláha, P., Jiroutová, L., Brabec, M., Vignerová, J. Využití růstových modelů ke konstrukci rychlostních křivek somatických znaků na základě dat semilongitudinální studie. Čs. Pediatr., 2007, 3, p. 133–145.

29. Kýr, M., Fedora, M., Elb, L., Kugan, N., Michálek, J. Modeling effect of the septic condition and trauma on C-reactive protein levels in children with sepsis: a retrospective study. Critical Care, 2007, 11. Dostupný na WWW: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17598889

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Anaesthesiology, Resuscitation and Inten Intensive Care Medicine

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