Assessment of a noninvasive cerebral oxygenation monitor in patients with severe traumatic brain injury

Clinical article

Guy Rosenthal M.D.1, Alex Furmanov R.N., B.S.N.1, Eyal Itshayek M.D.1, Yigal Shoshan M.D.1, and Vineeta Singh M.D.2
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  • 1 Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and
  • | 2 Department of Neurology, University of California, San Francisco, California
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Object

Development of a noninvasive monitor to assess cerebral oxygenation has long been a goal in neurocritical care. The authors evaluated the feasibility and utility of a noninvasive cerebral oxygenation monitor, the CerOx 3110, which uses near-infrared spectroscopy and ultrasound to measure regional cerebral tissue oxygenation in patients with severe traumatic brain injury (TBI), and compared measurements obtained using this device to those obtained using invasive cerebral monitoring.

Methods

Patients with severe TBI admitted to the intensive care unit at Hadassah-Hebrew University Hospital requiring intracranial pressure (ICP) monitoring and advanced neuromonitoring were included in this study. The authors assessed 18 patients with severe TBI using the CerOx monitor and invasive advanced cerebral monitors.

Results

The mean age of the patients was 45.3 ± 23.7 years and the median Glasgow Coma Scale score on admission was 5 (interquartile range 3–7). Eight patients underwent unilateral decompressive hemicraniectomy and 1 patient underwent craniotomy. Sixteen patients underwent insertion of a jugular bulb venous catheter, and 18 patients underwent insertion of a Licox brain tissue oxygen monitor. The authors found a strong correlation (r = 0.60, p < 0.001) between the jugular bulb venous saturation from the venous blood gas and the CerOx measure of regional cerebral tissue saturation on the side ipsilateral to the catheter. A multivariate analysis revealed that among the physiological parameters of mean arterial blood pressure, ICP, brain tissue oxygen tension, and CerOx measurements on the ipsilateral and contralateral sides, only ipsilateral CerOx measurements were significantly correlated to jugular bulb venous saturation (p < 0.001).

Conclusions

Measuring regional cerebral tissue oxygenation with the CerOx monitor in a noninvasive manner is feasible in patients with severe TBI in the neurointensive care unit. The correlation between the CerOx measurements and the jugular bulb venous measurements of oxygen saturation indicate that the CerOx may be able to provide an estimation of cerebral oxygenation status in a noninvasive manner.

Abbreviations used in this paper:

CBF = cerebral blood flow; CPP = cerebral perfusion pressure; FiO2 = fraction of inspired oxygen; GCS = Glasgow Coma Scale; ICP = intracranial pressure; MABP = mean arterial blood pressure; PbtO2 = partial pressure of brain tissue oxygen; rCsat = regional cerebral tissue oxygen saturation; SjvO2 = jugular bulb venous oxygen saturation; TBI = traumatic brain injury; UT-NIRS = ultrasound-tagged near-infrared spectroscopy.

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Contributor Notes

Address correspondence to: Guy Rosenthal, M.D., Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Kiryat Hadassah, Jerusalem, Israel 91120. email: rosenthalg@hadassah.org.il.

Please include this information when citing this paper: published online January 31, 2014; DOI: 10.3171/2013.12.JNS131089.

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