Comparison of a New Brain Tissue Oxygenation Probe with the Established Standard
Introduction: Continuous bedside brain tissue oxygenation (pbrO2) monitoring using the Licox system is an established method for detecting secondary ischemia in comatose patients with acute brain injury. The purpose of the current study was to compare the
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Abstract Introduction: Continuous bedside brain tissue oxygenation (pbrO2) monitoring using the Licox system is an established method for detecting secondary ischemia in comatose patients with acute brain injury. The purpose of the current study was to compare the newly introduced Raumedic pbrO2 probe with the established standard. Methods: Eighteen patients with acute traumatic brain injury or aneurysmal subarachnoid hemorrhage had pbrO2 probes of both types implanted side by side in the same vascular territory at risk of ischemia. Data were analyzed by the Bland–Altman method as well as random effect regression models to correct for multiple measurements per individual. Results: Both types of probes were able to display spontaneous fluctuations of pbrO2 as well as reactions to therapy. Mean measurement difference between the Licox and Raumedic probes was −2.3 mmHg, with corresponding 95% limits of agreement of −32.3 to 27.5 mmHg. Regarding an ischemia threshold of 15 mmHg, both probes were in agreement in 78% and showed disparate results in 22%. Conclusions: Our data suggest that the pbrO2 measurements of the two systems cannot be interchanged. Although we were unable to determine which system delivers more valid data, we do think that more rigorous testing is necessary before implementing the new probe in clinical routine. Keywords Brain tissue oxygenation • Monitoring • Ischemia • Licox • Raumedic
S. Wolf () Department of Neurosurgery, Campus Virchow, Charité University, Augustenburger Platz 1, Berlin 13353, Germany and Department of Neurosurgery, Klinikum Bogenhausen, Munich, Germany e-mail: [email protected] P. Horn, C. Frenzel, P. Vajkoczy, and J. Dengler Department of Neurosurgery, Campus Virchow, Charité University, Augustenburger Platz 1, Berlin 13353, Germany L. Schürer Department of Neurosurgery, Klinikum Bogenhausen, Munich, Germany
Introduction Continuous bedside brain tissue oxygenation (pbrO2) monitoring with the Licox system (Integra Neuroscience) is an established method of detecting secondary ischemia in comatose patients with acute brain injury. In patients after traumatic brain injury and subarachnoid hemorrhage, a relationship between pbrO2 monitoring and outcome has recently been established [1–3]. Owing to its stability and the lack of competition, the Licox pbrO2 sensor became the de facto gold standard. Recently, a new pbrO2 probe by a different manufacturer (Neurovent PTO, Raumedic) was introduced. This new probe facilitates concurrent measurement of intracranial pressure (ICP), brain temperature, and pbrO2. Therefore, its use would reduce the invasiveness of multimodal neuromonitoring. However, before new technology is introduced, its performance and compatibility with the existing standards need to be established. The ICP component of the new probe has shown favorable performance in bench testing and multicenter evaluation [4, 5]. The purpose of the present study was to investigate the level of agreement of pbrO2 values from the Licox and Raumedic probes in routine clinical use.
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