Reactivity of brain tissue oxygen to change in cerebral perfusion pressure in head injured patients

Danila K. Radolovich, Marek Czosnyka, Ivan Timofeev, Andrea Lavinio, Peter Hutchinson, Arun Gupta, John D. Pickard, Peter Smielewski

Research output: Contribution to journalArticle

Abstract

Objective: It has been reported recently that correlation between brain tissue oxygen (PbtO2) and cerebral perfusion pressure (CPP) may serve as an indicator of cerebral autoregulation after subarachnoid hemorrhage. We aimed to compare similar indices describing interaction between changes in intracranial pressure (ICP), arterial blood pressure (ABP), and brain tissue oxygen to verify their clinical utility in patients after traumatic brain injury. Materials and Methods: Retrospective analysis of multimodal monitoring of 32 patients suffering from head injury, admitted in the Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge, UK. Initial 24 h intervals of continuous ABP, ICP, and PbtO2 recordings were analyzed. Index of tissue oxygen reactivity ORx was evaluated as the correlation coefficient between PbtO2 and CPP over a period of 60 min and compared to the index of pressure reactivity PRx. "Optimal CPP" and a hypothetical "optimal PbtO2" were defined as the ranges of CPP and PbtO2 at which PRx or ORx were indicating best cerebrovascular milieu. Results: PRx and ORx mean values did not show any correlation with each other (R = 0.012; P = 0.95) between patients. There was also no correlation between ORx and PbtO2 (R = 0.098; P = 0.61) and between PRx and PbtO2 (R = 0.019; P = 0.923). No clear and consistent value of "optimal CPP" minimizing ORx or of hypothetical "optimal PbtO2" were found analyzing PbtO2 or ORx trend over the 24 h of monitoring. However, in most of patients 'optimal CPP' has been found for PRx index. The same has been confirmed when the data from whole monitoring period were analyzed. There was no correlation between values of 'optimal CPP' assessed using ORx and 'optimal CPP' assessed with PRx. Conclusion: The relationships between PbtO2, ORx, and CPP in head injury appear less useful than reported before for patients after subarachnoid hemorrhage.

Original languageEnglish
Pages (from-to)274-279
Number of pages6
JournalNeurocritical Care
Volume10
Issue number3
DOIs
Publication statusPublished - Jun 2009

Keywords

  • Autoregulation
  • Brain tissue oxygen
  • Cerebral perfusion pressure
  • Head injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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    Radolovich, D. K., Czosnyka, M., Timofeev, I., Lavinio, A., Hutchinson, P., Gupta, A., Pickard, J. D., & Smielewski, P. (2009). Reactivity of brain tissue oxygen to change in cerebral perfusion pressure in head injured patients. Neurocritical Care, 10(3), 274-279. https://doi.org/10.1007/s12028-009-9190-3