Abstract
Background/ObjectiveIn order to monitor tissue oxygenation in patients with acute neurological disorders, probes for measurement of brain tissue oxygen tension (ptO2) are often placed non-specifically in a right frontal lobe location. To improve the value of ptO2 monitoring, placement of the probe into a specific area of interest is desirable. We present a technique using CT-guidance to place the ptO2 probe in a particular area of interest based on the individual patient’s pathology.MethodsIn this retrospective cohort study, we analyzed imaging and clinical data from all patients who underwent CT-guided ptO2 probe placement at our institution between October 2017 and April 2019. Primary endpoint was successful placement of the probe in a particular area of interest rated by two independent reviewers. Secondary outcomes were complications from probe insertion, clinical consequences from ptO2 measurements, clinical outcome according to the modified Rankin Scale (mRS) as well as development of ischemia on follow-up imaging. A historical control group was selected from patients who underwent conventional ptO2 probe placement between January 2010 and October 2017.ResultsEleven patients had 16 CT-guided probes inserted. In 15 (93.75%) probes, both raters agreed on the correct placement in the area of interest. Each probe triggered on average 0.48 diagnostic or therapeutic adjustments per day. Only one infarction within the vascular territory of a probe was found on follow-up imaging. Eight out of eleven patients (72.73%) reached a good outcome (mRS ≤ 3). In comparison, conventionally placed probes triggered less diagnostic and therapeutic adjustment per day (p = 0.007). Outcome was worse in the control group (p = 0.024).ConclusionCT-guided probe insertion is a reliable and easy technique to place a ptO2 probe in a particular area of interest in patients with potentially reduced cerebral oxygen supply. By adjusting treatment aggressively according to this individualized monitoring data, clinical outcome may improve.
Highlights
Cerebral oxygen supply is a critical parameter in the treatment of patients with acute cerebral disorders such as traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH)
Several retrospective studies as well as a recent, prospective randomized phase II trial suggest a clinical benefit with improved outcome and lower mortality when guiding therapy according to ptO2 and intracranial pressure (ICP) compared to ICP alone in patients suffering from TBI [13,14,15,16,17,18,19]
We evaluated for the study and the historical control group complications from probe insertion, clinical consequences from ptO2 measurements, as well as clinical outcome according to the modified Rankin Scale after 6 months
Summary
Cerebral oxygen supply is a critical parameter in the treatment of patients with acute cerebral disorders such as traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH). Lower ptO2 values are associated with unfavorable outcome and higher mortality in clinical studies of patients with TBI [8, 9]. Several retrospective studies as well as a recent, prospective randomized phase II trial suggest a clinical benefit with improved outcome and lower mortality when guiding therapy according to ptO2 and intracranial pressure (ICP) compared to ICP alone in patients suffering from TBI [13,14,15,16,17,18,19]. The association of lower ptO2 values and outcome was only weak in clinical studies of patients suffering from SAH and results have been conflicting [12, 24, 25]. Detection of critical cerebral perfusion due to vasospasms in SAH patients depends on the positioning of the p tO2 probe, which might explain the conflicting results [25, 26]
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