Abstract
Background/objectiveMonitoring of brain tissue oxygen tension (PbtO2) provides insight into brain pathophysiology after intracerebral hemorrhage (ICH). Integration of probe location is recommended to optimize data interpretation. So far, little is known about the importance of PbtO2 catheter location in ICH patients.MethodsWe prospectively included 40 ICH patients after hematoma evacuation (HE) who required PbtO2-monitoring. PbtO2-probe location was evaluated in all head computed tomography (CT) scans within the first 6 days after HE and defined as location in the healthy brain tissue or perilesional when the catheter tip was located within 1 cm of a focal lesion (hypodense or hyperdense). Generalized estimating equations were used to investigate levels of PbtO2 in relation to different probe locations.ResultsPatients were 60 [51–66] years old and had a median ICH-volume of 47 [29–60] mL. Neuromonitoring probes remained for a median of 6 [2–11] days. PbtO2-probes were located in healthy brain tissue in 18/40 (45%) patients and in perilesional brain tissue in 22/40 (55%) patients. In the acute phase after HE (0–72 h), PbtO2 levels were significantly lower (21 ± 12 mmHg vs. 29 ± 10 mmHg, p = 0.010) and brain tissue hypoxia (BTH) was more common in the perilesional area as compared to healthy brain tissue (46% vs. 19%, adjOR 4.0, 95% CI 1.54–10.58, p = 0.005). Episodes of BTH significantly decreased over time in patients with probes in perilesional location (p = 0.001) but remained stable in normal appearing area (p = 0.485). A significant association between BTH and poor functional outcome was only found when probes were located in the perilesional brain tissue (adjOR 6.6, 95% CI 1.3–33.8, p = 0.023).ConclusionsIn the acute phase, BTH was more common in the perilesional area compared to healthy brain tissue. The improvement of BTH in the perilesional area over time may be the result of targeted treatment interventions and tissue regeneration. Due to the localized measurement of invasive neuromonitoring devices, integration of probe location in the clinical management of ICH patients and in research protocols seems mandatory.
Highlights
Despite improvements in the neurocritical care management of patients with hemorrhagic stroke over the past decades [1], intracerebral hemorrhage (ICH) is still a devastating disease associated with high rates of morbidity and mortality [2]
General inclusion criteria encompassed (1) admission with non-traumatic ICH diagnosed on cerebral imaging, (2) age ≥ 18 years, (3) hematoma evacuation, including the placement of invasive multimodal neuromonitoring as part of routine clinical care
There were no neurosurgical complications recorded within the study time, including instant rebleeding or infarction related to the surgical procedure
Summary
Despite improvements in the neurocritical care management of patients with hemorrhagic stroke over the past decades [1], intracerebral hemorrhage (ICH) is still a devastating disease associated with high rates of morbidity and mortality [2]. Primary placement of neuromonitoring catheters depends on the underlying disease entity, lesion location, and technical feasibility [4]. In patients with traumatic brain injury (TBI) P btO2 probes should be placed in the lesioned hemisphere (hemisphere with higher lesion load, respectively) in order to detect brain tissue hypoxia in areas at highest risk for secondary injury [3, 6]. Absolute PbtO2 values may differ depending on the type of probe used [7] and probe location [5, 6]
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