The Importance of P bt O 2 Probe Location for Data Interpretation in Patients with Intracerebral Hemorrhage
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ORIGINAL WORK
The Importance of PbtO2 Probe Location for Data Interpretation in Patients with Intracerebral Hemorrhage Anna Lindner1, Verena Rass1, Bogdan‑Andrei Ianosi1,4, Alois J. Schiefecker1, Mario Kofler1, Paul Rhomberg2, Bettina Pfausler1, Ronny Beer1, Erich Schmutzhard1, Claudius Thomé3 and Raimund Helbok1* © 2020 The Author(s)
Abstract Background/objective: Monitoring of brain tissue oxygen tension (PbtO2) provides insight into brain pathophysiol‑ ogy after intracerebral hemorrhage (ICH). Integration of probe location is recommended to optimize data interpreta‑ tion. So far, little is known about the importance of PbtO2 catheter location in ICH patients. Methods: We 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 P btO2 in relation to different probe locations. Results: Patients 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), P btO2 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 out‑ come was only found when probes were located in the perilesional brain tissue (adjOR 6.6, 95% CI 1.3–33.8, p = 0.023). Conclusions: In 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. Keywords: Intracerebral hemorrhage, Neuromonitoring parameter, Critical care, Neurology
*Correspondence: raimund.helbok@tirol‑kliniken.at; raimund. helbok@i‑med.ac.at 1 Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria Full list of author information is available at the end of the article
Introduction Despite improvements in the neurocritical care management of patients with hemorrhagic stroke over the past decades [1], intracerebral hem
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