Document Detail


Open lung ventilation in neurosurgery: an update on brain tissue oxygenation.
MedLine Citation:
PMID:  16463830     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Recently, we showed the feasibility of ventilating neurosurgical patients with acute intracranial pathology and concomitant acute respiratory distress syndrome (ARDS) according the so-called Open Lung approach. This technique consists of low tidal volume, elevated positive expiratory pressure (PEEP) level and initial recruitment maneuvers to open up collapsed alveoli. In this report, we focus on our experience to guide recruitment with brain tissue oxygenation (pbrO2) probes. We studied recruitment maneuvers in thirteen patients with ARDS and acute brain injury such as subarachnoid hemorrhage and traumatic brain injury. A pbrO2 probe was implanted in brain tissue at risk for hypoxia. Recruitment maneuvers were performed at an inspired oxygen frcation (FiO2) of 1.0 and a PEEP level of 30 40 cmH2O for 40 seconds. The mean FiO2 necessary for normoxemia could be decreased from 0.85 +/- 0.17 before recruitment to 0.55 +/- 0.12 after 24 hours, while mean PbrO2 (24.6 mmHg before recruitment) did not change. At a mean of 17 minutes after the first recruitment maneuver, PbrO2 showed peak a value of 35.6 +/- 16.6 mmHg, reflecting improvement in arterial oxygenation at an FiO2 of 1.0. Brain tissue oxygenation monitoring provides a useful adjunct to estimate the effects of recruitment maneuvers and ventilator settings in neurosurgical patients with acute lung injury.
Authors:
S Wolf; D V Plev; H A Trost; C B Lumenta
Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Acta neurochirurgica. Supplement     Volume:  95     ISSN:  0065-1419     ISO Abbreviation:  Acta Neurochir. Suppl.     Publication Date:  2005  
Date Detail:
Created Date:  2006-02-08     Completed Date:  2006-03-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100962752     Medline TA:  Acta Neurochir Suppl     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  103-5     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Academic Hospital Munich-Bogenhausen, Technical University of Munich, Munich, Germany. Neurochirurgie.Bogenhausen@lrz.tum.de
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Brain / metabolism*
Brain Injuries / complications,  diagnosis*,  metabolism,  surgery*
Humans
Intracranial Pressure*
Monitoring, Physiologic / methods*
Neurosurgery / methods
Oxygen / analysis,  metabolism*
Positive-Pressure Respiration / methods*
Preoperative Care / methods
Respiratory Distress Syndrome, Adult / diagnosis*,  metabolism,  surgery
Treatment Outcome
Chemical
Reg. No./Substance:
7782-44-7/Oxygen

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