Brain oxygenation monitoring

Abstract

Prikaz slučaja | Case reportDeskriptori CEREBRALNA OKSIGENACIJA; JUGULARNA VENSKA SATURACIJA KISIKOM; PARCIJALNI TLAK O2 U MOŽDANOM TKIVU; NEAR-INFRACRVENA SPEKTROSKOPIJA SAŽETAK. Održavanje adekvatne opskrbe mozga kisikom sukladno metaboličkim potrebama ključan je korak u zbrinjavanju pacijenta s akutnom ozljedom mozga u okviru Jedinice intenzivnog liječenja (JIL), bilo da se radi o pacijentima s traumatskom ozljedom mozga (eng. Traumatic brain injury, TBI), intracerebralnim (ICH) ili subarahnoidalnim krvarenjem (SAH), odnosno o perioperativnom zbrinjavanju pacijenata u okviru neurokirurških, kardiokirurških ili zahvata vaskularne kirurgije. Ti su pacijenti pod povećanim rizikom razvoja sekudarne ozljede mozga posljedično hipoksiji i ishemiji. Upravo je s ciljem sprječavanja sekundarne ozljede mozga započeto s monitoriranjem moždane oksigenacije. Dostupne se metode mogu podijeliti na neinvazivne -trenutno je jedina dostupna near-infracrvena spektroskopija (NIRS), i invazivne poput monitoriranja jugularne venske saturacije kisikom (SjvO2) i monitoriranja parcijalnog tlaka kisika u moždanom parenhimu (PtiO2). Svaka od metoda ima svoje prednosti, ali i nedostatke, uz mjesto u kliničkom radu, te će isti uz opis metode i kliničku primjenu biti prikazani u ovome radu. Descriptors CEREBRAL OXYGENATION; JUGULAR VENOUS SATURATION; BRAIN TISSUE OXYGEN TENSION; NEAR-INFRARED SPECTROSCOPY SUMMARY.Maintaining an adequate oxygen supply to the brain in accordance with metabolic needs is a key step in the management of patients with acute brain injury in the Intensive Care Unit (ICU), whether they are patients with traumatic brain injury (TBI), intracerebral (ICH) or subarachnoid hemorrhage (SAH), or during the perioperative care of patients in whom neurosirguical, cardiosurgical or vascular surgery procedures are planned. These patients are at increased risk of developing secondary brain injury as a result of hypoxia and ischemia. Brain oxygenation monitoring was developed with the aim of preventing secondary brain injury. Available methods can be divided into non-invasive -currently the only one available is near-infrared spectroscopy (NIRS), and invasive such as monitoring of jugular venous oxygen saturation (SjvO2) and monitoring of the partial pressure of oxygen in the brain parenchyma (PtiO2). Each of the methods has its own advantages and disadvantages, with its purpose in clinical setting, and the same will be presented in this paper along with the description of the method and its clinical application.