Cerebral microdialysis and Pti<scp>o</scp>2 for neuro‐monitoring before decompressive craniectomy

Boret, Henry; Fesselet, J.; Meaudre, Éric; Gaillard, P; Cantais, E.

doi:10.1111/j.1399-6576.2005.00862.x

Cited by 24 publications

(16 citation statements)

References 16 publications

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“…And finally, does elevation of ICP matter if clinically adequate levels of CPP are maintained? Reports from several authors suggest that metabolic derangements detectable with microdialysis can indeed precede substantial rises in ICP (Belli et al, 2008;Boret et al, 2006). This relationship was also seen in some of our patients, however, far more common observations included (near) simultaneous changes in ICP and LP ratio or other metabolic parameters, or episodes where ICP elevations were not associated with any change in biochemistry, before or after an event.…”

Section: Icp and Microdialysissupporting

confidence: 73%

Interaction between Brain Chemistry and Physiology after Traumatic Brain Injury: Impact of Autoregulation and Microdialysis Catheter Location

Timofeev

Czosnyka

Carpenter

et al. 2011

Journal of Neurotrauma

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Bedside monitoring of cerebral metabolism in traumatic brain injury (TBI) with microdialysis is gaining wider clinical acceptance. The objective of this study was to examine the relationship between the fundamental physiological neuromonitoring modalities intracranial pressure (ICP), cerebral perfusion pressure (CPP), brain tissue oxygen (P bt O 2 ), and cerebrovascular pressure reactivity index (PRx), and cerebral chemistry assessed with microdialysis, with particular focus on the lactate/pyruvate (LP) ratio as a marker of energy metabolism. Prospectively collected observational neuromonitoring data from 97 patients with TBI, requiring neurointensive care management and invasive cerebral monitoring, were analyzed. A linear mixed model analysis was used to account for individual patient differences. Perilesional tissue chemistry exhibited a significant independent relationship with ICP, P bt O 2 and CPP thresholds, with increasing LP ratio in response to decrease in P bt O 2 and CPP, and increase in ICP. The relationship between CPP and chemistry depended upon the state of PRx. Within the studied physiological range, tissue chemistry only changed in response to increasing ICP or drop in P bt O 2 < 1.33 kPa (10 mmHg). In agreement with previous studies, significantly higher levels of cerebral lactate ( p < 0.001), glycerol ( p = 0.013), LP ratio ( p < 0.001) and lactate/glucose (LG) ratio ( p = 0.003) were found in perilesional tissue, compared to ''normal'' brain tissue (Mann-Whitney test). These differences remained significant following adjustment for the influences of other important physiological parameters (ICP, CPP, P bt O 2 , P bt CO 2 , PRx, and brain temperature; mixed linear model), suggesting that they may reflect inherent tissue properties related to the initial injury. Despite inherent biochemical differences between less-injured brain and ''perilesional'' cerebral tissue, both tissue types exhibited relationships between established physiological variables and biochemistry. Decreases in perfusion and oxygenation were associated with deteriorating neurochemistry and these effects were more pronounced in perilesional tissue and when cerebrovascular reactivity was impaired.

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Section: Icp and Microdialysissupporting

confidence: 73%

Interaction between Brain Chemistry and Physiology after Traumatic Brain Injury: Impact of Autoregulation and Microdialysis Catheter Location

Timofeev

Czosnyka

Carpenter

et al. 2011

Journal of Neurotrauma

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“…Another study has concluded that " …pbtO2 monitoring could be an important tool for timing craniectomy in the future" [221]. This report is supported by a case report [205]. The effects of DCH, which represents a very invasive treatment option and which is considered an ultimate surgical treatment option has also been studied: "DCH in the treatment of severe brain injury is associated with a significant improvement in brain oxygenation" [6].…”

Section: Decompressive Craniectomy and Ventricular Drainagementioning

confidence: 73%

“…There are publications also from Australia [38,[198][199][200], Austria [53,85], Brazil [58], Canada [93,118,132,135,139], China [9, 201,202], Croatia [203], the Czech Republic [204], Denmark [134]; Finland [134], France [43,77,114,205,206], Greece [207], Hungary [141], India [208], Japan [140,146,167,209], Portugal [64]; Russia [210,211], Singapore [2,4,10,16,74,212,213]; Serbia [214]; South Africa [26,28,35], South Korea [127], Sweden [90,134,215], Switzerland [11,216,217]...…”

Section: Clinical Applicationsmentioning

confidence: 99%

Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

Lang

Jaeger²

2013

TOCCMJ

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This review has been compiled to assess publications related to the clinical application of direct cerebral tissue oxygenation (pbtO2) monitoring published in international, peer-reviewed scientific journals, or major meeting reports published as journal supplements. Its goal was to extract relevant, i.e. positive and negative, information on indications, clinical application, safety issues and impact on clinical situations, as well as treatment strategies in neurosurgery, neurosurgical anaesthesiology, neurosurgical intensive care, neurology, and related specialties. For completeness' sake it also presents related basic science research and case reports. This review is an update of its previous edition published elsewhere in 2007. This review reflects publications from 2004 to 2012. Only relevant publications prior to 2004, which explicitly addressed or systematically examined the above issues, are included in this review and are listed in the reference section. Based on 349 citations it is the most comprehensive review available on direct cerebral oxygen monitoring to this date.Keywords: Review, cerebral oxygenation, raumedic, licox, neurotrend, cerebral partial pressure of oxygen, brain tissue oxygenation. METHODSThis review is based on a systematic "Medline" literature search using the following search terms: licox, neurotrend, neurovent, raumedic, brain tissue oxygen, brain tissue oxygenation, cerebral oxygenation, cerebral tissue oxygen, cerebral partial pressure of oxygen, btO2, ptiO2, pti(O)2, ptiO(2), pbrO2, PBr(O2), P(bt)O(2), P(br)O(2), PbrO(2), BTpO2, tP(O2), PbO2, PbtO2, Pbto, PbtO(2).Only few publications were not retrieved using this technique. They were, however, identified through personal communication with scientists in the field, meeting proceedings and reviewer assignments. This strategy provided sufficient certainty that relevant papers have not been missed. Unpublished meeting abstracts and published conference proceedings were excluded for this review expect for few which provided comparative studies between different probes. To address relevant matters, related to specific pbtO2 issues, selected non-peer reviewed papers published in supplements were also used only when no other peer-reviewed information was available. RESULTSThis review is based on a previous review [1]. It is currently based on 349 papers, 274 more papers compared to its previous version in 2007, which warrants the update.

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“…8 However to offer added value over and above that provided by other intracranial monitors, cerebral MD must not only guide treatment, but do so in a way that reduces the burden of secondary brain injury and thereby offer the potential to improve functional outcome in survivors.…”

Section: Clinical Applications Of MD Monitoringmentioning

confidence: 99%

Cerebral Microdialysis: Research Technique or Clinical Tool?

Borg¹,

Smith²

2012

Microdialysis Techniques in Neuroscience

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SummaryCerebral microdialysis is a well-established laboratory tool that is increasingly used as a bedside monitor to provide on-line analysis of brain tissue biochemistry during neurointensive care. This review describes the principles of cerebral microdialysis and the rationale for its use in the clinical setting, including discussion of the most commonly used microdialysis biomarkers of acute brain injury. Potential clinical applications are reviewed and future research applications identified. Microdialysis has the potential to become an established part of mainstream multimodality monitoring during the management of acute brain injury but at present should be considered a research tool for use in specialist centres.

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Cerebral microdialysis and P_tio₂ for neuro‐monitoring before decompressive craniectomy

Cited by 24 publications

References 16 publications

Interaction between Brain Chemistry and Physiology after Traumatic Brain Injury: Impact of Autoregulation and Microdialysis Catheter Location

Interaction between Brain Chemistry and Physiology after Traumatic Brain Injury: Impact of Autoregulation and Microdialysis Catheter Location

Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

Cerebral Microdialysis: Research Technique or Clinical Tool?

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Cerebral microdialysis and Ptio2 for neuro‐monitoring before decompressive craniectomy

Cited by 24 publications

References 16 publications

Interaction between Brain Chemistry and Physiology after Traumatic Brain Injury: Impact of Autoregulation and Microdialysis Catheter Location

Interaction between Brain Chemistry and Physiology after Traumatic Brain Injury: Impact of Autoregulation and Microdialysis Catheter Location

Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

Cerebral Microdialysis: Research Technique or Clinical Tool?

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Product

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Cerebral microdialysis and P_tio₂ for neuro‐monitoring before decompressive craniectomy