Document Detail

Monitoring brain tissue oxygen tension in brain-injured patients reveals hypoxic episodes in normal-appearing and in peri-focal tissue.
MedLine Citation:
PMID:  17846748     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: We compared brain tissue oxygen tension (PtiO2) measured in peri-focal and in normal-appearing brain parenchyma on computerized tomography (CT) in patients following traumatic brain injury (TBI). DESIGN: Prospective observational study. SETTING: Neurointensive care unit. PATIENTS AND PARTICIPANTS: Thirty-two consecutive TBI patients were subjected to PtiO2 monitoring. INTERVENTIONS: Peri-focal tissue was identified by the presence of a hypodense area of the contusion and/or within 1 cm from the core of the contusion. The position of the tip of the PtiO2 probe was assessed at follow-up CT scan. MEASUREMENTS AND RESULTS: Mean PtiO2 in the peri-contusional tissue was 19.7+/-2.1 mmHg and was lower than PtiO2 in normal-appearing tissue (25.5+/-1.5 mmHg, p < 0.05), despite a greater cerebral perfusion pressure (CPP) (73.7+/-2.3 mmHg vs. 67.4+/-1.4 mmHg, p < 0.05). We observed both in peri-focal tissue and in normal-appearing tissue episodes of brain hypoxia (PtiO2 < 20 mmHg for at least 10 min), whose median duration was longer in peri-focal tissue than in normal-appearing tissue (51% vs. 34% of monitoring time, p < 0.01). In peri-focal tissue, we observed a progressive PtiO2 increase from pathologic to normal values (p < 0.01). CONCLUSIONS: Multiple episodes of brain hypoxia occurred over the first 5 days following severe TBI. PtiO2 was lower in peri-contusional tissue than in normal-appearing tissue. In peri-contusional tissue, a progressive increase of PtiO2 from pathologic to normal values was observed over time, suggestive of an improvement at microcirculatory level.
Luca Longhi; Francesca Pagan; Valerio Valeriani; Sandra Magnoni; Elisa R Zanier; Valeria Conte; Vincenzo Branca; Nino Stocchetti
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Publication Detail:
Type:  Journal Article     Date:  2007-09-01
Journal Detail:
Title:  Intensive care medicine     Volume:  33     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-11-23     Completed Date:  2008-05-15     Revised Date:  2009-01-08    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2136-42     Citation Subset:  IM    
University of Milano, Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena,Neurosurgical Intensive Care Unit, Department of Anesthesia and Critical Care Medicine, Via Sforza n 35, 20100 Milan, Italy.
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MeSH Terms
Aged, 80 and over
Brain Injuries / physiopathology*,  radiography
Cerebrovascular Circulation / physiology
Hypoxia-Ischemia, Brain / physiopathology*
Middle Aged
Monitoring, Physiologic / methods
Oxygen / metabolism*
Prospective Studies
Tomography, X-Ray Computed
Reg. No./Substance:
Comment In:
Intensive Care Med. 2008 Jun;34(6):1156-7; author reply 1158-9   [PMID:  18365172 ]

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