Monitoring PtiO2 and Changes in Oxygen Fraction in the Breathed Mixture after Severe Subarachnoid Haemorrhage


Authors: M. Smrčka;  E. Neuman;  K. Ďuriš;  T. Svoboda;  M. Duba
Authors‘ workplace: Neurochirurgická klinika LF MU a FN Brno
Published in: Cesk Slov Neurol N 2010; 73/106(6): 694-700
Category: Original Paper

Overview

Introduction:
The aim of this study was to evaluate any possible improvement in outcome for post-severe-SAH patients that might result from monitoring tissue oxygen in the brain (PtiO2, Licox system) and manipulation of the fraction of oxygen in the inhaled mixture of gases (FiO2) with respect to PtiO2 value. Material and methods: 45 patients with aneurysm SAH HH 3, 4 and 5 were enrolled in the study (2007–2009). All patients were artificially ventilated. The first group consisted of 22 patients with SAH HH 4 and 5 treated by coiling. The second group consisted of 23 patients with SAH HH 3 and 4 treated by clipping. The groups were randomly divided into experimental and control subgroups. In the experimental subgroups, PtiO2 was monitored. If the PtiO2 value dropped below 15 mmHg and had not improved after 30 minutes, FiO2 was increased from the default values (range 40–55%) to higher levels (range 70–85%). If the PtiO2 level reached 15 mmHg for at least an hour, FiO2 was brought back to a lower level. Treatment outcome was quantified using the Glasgow Outcome Scale (GOS) and evaluated 3 months after the SAH. Results: The treatment results for patients with and without the use of PtiO2 monitoring did not differ statistically. ­Conclusion: Therapy with FiO2 manipulation subsequent to PtiO2 measurements did not improve the outcome in patients suffering from SAH, HH 3, 4 and 5. It appears likely that vasospasm prevents PtiO2 increase in response to FiO2 elevation.

Keywords:
brain tissue oxygen – subarachnoid haemorrhage – vasospasm


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Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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