Correlation of noninvasive cerebral oximetry with cerebral perfusion in the severe head injured patient: a pilot study.

Title

Correlation of noninvasive cerebral oximetry with cerebral perfusion in the severe head injured patient: a pilot study.

Creator

Dunham CM; Sosnowski C; Porter J M; Siegal J; Kohli C

Publisher

Journal of Trauma

Date

2002
2002-01

Description

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in trauma patients. Cerebral perfusion pressure (CPP) directed ICU management is recommended for patients with severe TBI. It, however, requires an invasive device to measure intracranial pressure (ICP). Transcranial cerebral oximetry is a noninvasive method utilizing near-infrared technology to indirectly measure cerebral saturation (StCO2). METHODS: A prospective observational study was performed at a Level I trauma center. Data were collected hourly for the first 6 days on four patients with severe TBI. Each patient had ICP monitoring and StCO2 (INVOS, Somanetics) assessed from each frontal lobe. CPP directed care was used. RESULTS: Four patients with TBI, with admission GCS scores of 4, 4, 7, and 8, all had subdural hematomas and contusions; three had subarachnoid hemorrhage (SAH); one had an epidural hematoma (the only death; day 6); two had craniotomies. In the first 48 hours when CPP \textgreater or = 70, StCO2 was 71 +/- 9, while it was 61 +/- 9 when CPP \textless 70 (p \textless 0.0001). This relationship was constant for all study days, with p \textless 0.0001. Moreover, CPP \textless 70 correlated with StCO2 with r = 0.8l and r(2) = 0.66. StCO2 \textgreater or = 75 was associated with CPP \textgreater or = 70 96.4% of the time (95% CL, 94.3-98.5%). StCO2 \textless 55 was associated with CPP \textless 70 68.2% of the time (95% CL, 57-79.4%). Also, 13.4% of observations with CPP \textgreater or = 70 had StCO2 \textless 60, suggesting the potential of cerebral ischemia in the face of 'normal' CPP. The StCO2 patches were user-friendly and not technically finicky. CONCLUSION: In this pilot study, StCO2 correlated significantly with CPP. A StCO2 \textgreater or = 75 suggests that CPP is adequate, while \textless 55 suggests an inadequate CPP. Although these results should be confirmed in a larger study, StCO2 may serve as a noninvasive measurement of cerebral perfusion in the patient with a TBI or, at the very least, a sensitive indicator for the need to begin monitoring the ICP.

Subject

Adult; Female; Male; Prospective Studies; Confidence Intervals; Human; Convenience Sample; Chi Square Test; Data Analysis Software; Pilot Studies; Middle Age; Fisher's Exact Test; Pearson's Correlation Coefficient; T-Tests; Oximetry; Monitoring; Linear Regression; Tissue Perfusion; Intracranial Pressure; Head Injuries – Therapy

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

40–46

Issue

1

Volume

52

Citation

Dunham CM; Sosnowski C; Porter J M; Siegal J; Kohli C, “Correlation of noninvasive cerebral oximetry with cerebral perfusion in the severe head injured patient: a pilot study.,” NEOMED Bibliography Database, accessed October 16, 2021, https://neomed.omeka.net/items/show/6137.

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