Individualized Brain Tissue Oxygen-Monitoring Probe Placement Helps to Guide Therapy and Optimizes Outcome in Neurocriti
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ORIGINAL WORK
Individualized Brain Tissue Oxygen‑Monitoring Probe Placement Helps to Guide Therapy and Optimizes Outcome in Neurocritical Care Levin Häni1* , Mario D. Ropelato1, Franca Wagner2, Andreas Nowacki1, Nicole Söll1, Matthias Haenggi3, Andreas Raabe1 and Werner J. Z’Graggen1 © 2020 The Author(s)
Abstract Background/Objective: In 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 p tO2 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. Methods: In 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. Results: Eleven 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). Conclusion: CT-guided probe insertion is a reliable and easy technique to place a p tO2 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.
*Correspondence: [email protected] 1 Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland Full list of author information is available at the end of the article
The statistical analysis was performed by Levin Häni (Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland).
Keywords: Traumatic brain injury, Brain hypoxia, Cerebral vasospasm, Subarachnoid hemorrhage
Introduction Cerebral oxygen supply is a critical parameter in the treatment of patients with acute cerebral disorders such as traumatic brain injury (TBI) and subarachnoid hemorrhag
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