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Matthias Menzel, Egon M. R. Doppenberg, Alois Zauner, Jens Soukup, Michael M. Reinert and Ross Bullock

arterial O 2 concentrations. 36, 40, 44, 53, 58 In these animal studies brain tissue oxygenation was monitored using different technical approaches in healthy noninjured brains. Van Santbrink, et al., 58 first described the effect of increasing brain tissue PO 2 in patients with severe head injury in response to normobaric hyperoxia induced by mechanical ventilation with 100% inspiratory O 2 over a period of approximately 30 minutes. This pilot study has shown that increasing the PaO 2 to levels higher than needed to fully saturate hemoglobin apparently can

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Sandra Magnoni, Laura Ghisoni, Marco Locatelli, Mariangela Caimi, Angelo Colombo, Valerio Valeriani and Nino Stocchetti

the bedside. Normobaric hyperoxia, which is achieved by ventilation with pure O 2 , has recently been reinvestigated as a potential therapeutic intervention after head injury. It was shown to reduce brain lactate concentrations in the early phase after trauma in humans, leading the authors of these studies 16, 26 to conclude that it improved cerebral oxidative metabolism. We are concerned about the rationale for using high O 2 tension to boost the supply to hypoxic tissues, because, although it slightly increases the O 2 carrying capacity of blood, O 2

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effects of HBO in favoring recoupling of CBF and metabolism, at least in subgroups of patients, and the possible superiority of HBO over normobaric hyperoxia. This is very interesting, but clearly beyond the limits of our findings. References 1. Gjedde A , Marrett S , Vafaee M : Oxidative and nonoxidative metabolism of excited neurons and astrocytes. J Cereb Blood Flow Metab 22 : 1 – 14 , 2002 Gjedde A, Marrett S, Vafaee M: Oxidative and nonoxidative metabolism of excited neurons and astrocytes. J Cereb Blood Flow

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Indra Yousry Bernhard Moriggl Markus Holtmannspoetter Urs D. Schmid Thomas P. Naidich Tarek A. Yousry September 2004 101 3 427 434 10.3171/jns.2004.101.3.0427 Normobaric hyperoxia—induced improvement in cerebral metabolism and reduction in intracranial pressure in patients with severe head injury: a prospective historical cohort—matched study Christos M. Tolias Michael Reinert Rolf Seiler Charlotte Gilman Alexander Scharf M. Ross Bullock September 2004 101 3 435 444 10.3171/jns.2004

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Christos M. Tolias, Michael Reinert, Rolf Seiler, Charlotte Gilman, Alexander Scharf and M. Ross Bullock

extracellular fluid of the brain. Similar work in animal models of stroke has confirmed that normobaric hyperoxia attenuates abnormalities identified on diffusion magnetic resonance imaging and reduces infarct volume 52 without increasing oxidative stress. 53 The exact effects of normobaric hyperoxia on cerebral metabolism within the pathophysiology of human TBI, however, remain poorly understood. As a result, controversy over the effectiveness of such an intervention remains. 7, 32 In this study, which was performed in two large neurosurgical ICUs, we tested the

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Taek Hyun Kwon, Dong Sun, Wilson P. Daugherty, Bruce D. Spiess and M. Ross Bullock

–1518, 1981 45. Siesjo BK , Siesjo P : Mechanisms of secondary brain injury. Eur J Anaesthesiol 13 : 247 – 268 , 1996 Siesjo BK, Siesjo P: Mechanisms of secondary brain injury. Eur J Anaesthesiol 13: 247–268, 1996 46. Singhal AB , Dijkhuizen RM , Rosen BR , Lo EH : Normobaric hyperoxia reduces MRI diffusion abnormalities and infarct size in experimental stroke. Neurology 58 : 945 – 952 , 2002 Singhal AB, Dijkhuizen RM, Rosen BR, Lo EH: Normobaric hyperoxia reduces MRI diffusion

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Michael F. Stiefel, Alejandro Spiotta, Vincent H. Gracias, Alicia M. Garuffe, Oscar Guillamondegui, Eileen Maloney-Wilensky, Stephanie Bloom, M. Sean Grady and Peter D. LeRoux

: Cerebral oxygenation following decompressive hemicraniectomy for the treatment of refractory intracranial hypertension. J Neurosurg 101 : 241 – 247 , 2004 Stiefel MF, Heuer GG, Smith MJ, Bloom S, Maloney-Wilensky E, Grady MS, et al: Cerebral oxygenation following decompressive hemicraniectomy for the treatment of refractory intracranial hypertension. J Neurosurg 101: 241–247, 2004 45. Tolias CM , Reinert M , Seiler R , Gilman C , Scharf A , Bullock MR : Normobaric hyperoxia—induced improvement in cerebral

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Gaylan L. Rockswold, Robert R. Quickel and Sarah B. Rockswold

Object The effect of normobaric hyperoxia (fraction of inspired O 2 [FIO 2 ] concentration 100%) in the treatment of patients with traumatic brain injury (TBI) remains controversial. The aim of this study was to investigate the effects of normobaric hyperoxia on five cerebral metabolic indices, which have putative prognostic significance following TBI in humans. Methods At two independent neurointensive care units, the authors performed a prospective study of 52 patients with severe TBI who were treated for 24 hours with 100% FIO 2 , starting within

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Bizhan Aarabi, Dale C. Hesdorffer, Edward S. Ahn, Carla Aresco, Thomas M. Scalea and Howard M. Eisenberg

outcome may reflect the introduction of CT scanning, better prehospital care, earlier and more aggressive surgical and intensive care of patients with TBI, and application of the Guidelines for the Management of Severe Head Injury. 6 , 18 , 22 , 40 , 75 , 76 , 78 New clinical research has provided evidence that decompressive craniectomy may mprove O 2 delivery to brain cells when the incidence of cerebral ischemia is at its peak. 54 , 109 Data from clinical and animal studies are inconclusive regarding whether normobaric hyperoxia is beneficial after TBI. 1 , 113

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Michael F. Stiefel, Joshua D. Udoetuk, Phillip B. Storm, Leslie N. Sutton, Heakyung Kim, Troy E. Dominguez, Mark A. Helfaer and Jimmy W. Huh

, Scharf A , Bullock MR : Normobaric hyperoxia—induced improvement in cerebral metabolism and reduction in intracranial pressure in patients with severe head injury: a prospective historical cohort-matched study . J Neurosurg 101 : 435 – 444 , 2004 43 Valadka AB , Gopinath SP , Contant CF , Uzura M , Robertson CS : Relationship of brain tissue PO 2 to outcome after severe head injury . Crit Care Med 26 : 1576 – 1581 , 1998 44 van den Brink WA , van Santbrink H , Steyerberg EW , Avezaat CJJ , Suazo JA , Hogesteeger C