Extended neuromonitoring

New therapeutic opportunities?

A. Zauner, E. Doppenberg, J. Soukup, M. Menzel, H. F. Young, Ross Bullock

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

In order to optimize therapy for the injured brain it is desirable to continuously monitor substrate delivery in the critically ill patient. Interruption of substrate delivery is a major factor of the great vulnerability to ischemic damage, which affects a majority of patients after severe head injury, stroke or subarachnoid hemorrhage. An approach to protecting the brain during ischemia is to increase the delivery of oxygen via residual blood flow through ischemic tissue. Hypothermia is also an important means of protecting brain cells from the deleterious effects of ischemia, after severe head injury, because it reduces metabolic demands. In this study we continuously measured brain oxygen, brain CO2, brain pH and brain temperature, as well as hourly brain glucose and lactate. A multiparameter sensor was inserted into brain tissue, via a three lumen bolt, along with a ventriculostomy catheter and a microdialysis probe in 60 severely head injured patients. Brain oxygen delivery was increased by stepwise increase of inspired oxygen (FiO2) from 30% to 60% to 100% over a period of 6 h, in order to test the effect of enhanced oxygen tension, on tissue oxygen. In most patients brain oxygen was initially low, and progressively increased, over the monitoring period, to a steady state level, around 30-40 mmHg. In those who died or remained vegetative, brain oxygen fell to anerobic levels. Episodes of increased ICP (n = 25), hypotension (n = 15), and respiratory difficulties (n = 9) caused an immediate increase in brain CO2. Multiple logistic regression analysis showed brain oxygen to be the strongest predictor for outcome in these patients. By increasing FiO2, an increase in oxygen delivery of more than 100%, and a simultaneous decline in lactate production was seen (p < 0.01). Brain temperature was closely related to rectal temperature, brain oxygen, and cerebral blood flow. Patients who were spontaneously hypothermic had a poor outcome (p < 0.01). A fuller understanding of dynamic factors affecting brain metabolism and substrate delivery may be obtained with extended neuromonitoring.

Original languageEnglish
JournalNeurological Research
Volume20
Issue numberSUPPL. 1
StatePublished - May 27 1998
Externally publishedYes

Fingerprint

Brain
Oxygen
Therapeutics
Craniocerebral Trauma
Temperature
Lactic Acid
Cerebrovascular Circulation
Ventriculostomy
Microdialysis
Subarachnoid Hemorrhage
Hypothermia
Brain Ischemia
Critical Illness
Hypotension
Ischemia
Catheters
Logistic Models
Stroke
Head
Regression Analysis

Keywords

  • Brain carbon dioxode
  • Brain chemistry
  • Brain oxygen
  • Brain pH
  • Brain temperature
  • New therapies

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Zauner, A., Doppenberg, E., Soukup, J., Menzel, M., Young, H. F., & Bullock, R. (1998). Extended neuromonitoring: New therapeutic opportunities? Neurological Research, 20(SUPPL. 1).

Extended neuromonitoring : New therapeutic opportunities? / Zauner, A.; Doppenberg, E.; Soukup, J.; Menzel, M.; Young, H. F.; Bullock, Ross.

In: Neurological Research, Vol. 20, No. SUPPL. 1, 27.05.1998.

Research output: Contribution to journalArticle

Zauner, A, Doppenberg, E, Soukup, J, Menzel, M, Young, HF & Bullock, R 1998, 'Extended neuromonitoring: New therapeutic opportunities?', Neurological Research, vol. 20, no. SUPPL. 1.
Zauner A, Doppenberg E, Soukup J, Menzel M, Young HF, Bullock R. Extended neuromonitoring: New therapeutic opportunities? Neurological Research. 1998 May 27;20(SUPPL. 1).
Zauner, A. ; Doppenberg, E. ; Soukup, J. ; Menzel, M. ; Young, H. F. ; Bullock, Ross. / Extended neuromonitoring : New therapeutic opportunities?. In: Neurological Research. 1998 ; Vol. 20, No. SUPPL. 1.
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