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  • Monitoring of tissue oxymetry and cerebral blood flow for the detection and the treatment of cerebral ischemia in patients after severe subarachnoideal hemorrhage

    Final Number:
    1295

    Authors:
    Martin Smrcka; Vilem Juran; Ondrej Navratil; Eduard Neuman; Andrej Mrlian; Kamil Duris; Roman Gal

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: The aim of the research is to evaluate possible better outcome in the patients after subarachnoideal hemorrhage (SAH) Hunt Hess grade IV – V, endangered with the development of vasospasms followed by several ischemic complications, with the help of tissue oxymetry (PbtO2) and cerebral blood flow (CBF) measurement.

    Methods: We have enrolled 11 patients so far (2011-2012) who suffered from SAH HH grade IV – V., with established aneurysm bleeding source. All the patients were artificially ventilated; aneurysms were treated either with clipping (n=8) or coiling (n=3). The patients have been continually monitored with ICP, PbtO2 (Licox) and CBF (Hemedex). All values were registered every hour and statistically analysed. All patients underwent daily measurement of TCD for evidence of vasospasm. The treatment result has been assessed with GOS score after three months from SAH.

    Results: We obtained 998 hours of measurement, the shortest recording takes 92 hours, the longest 230 hours. The monitored parameters oscillated in the following limits (arithmetic average ± standard deviation): ICP 11,9±4,8 mmHg, PbtO2 26,8±8,1 mmHg, CBF 20,9±11,5 ml/100g/min, MABP 98,5±12,6 mmHg. After statistic evaluation (Pearson correlation coefficient) we found out a strong inversely proportional correlation between ICP and CBF and between ICP and PbtO2. A good correlation between averaged 6 hour measurement interval of PbtO2 and corresponding TCD measurement has been disclosed - R = - 0,81. With regards to GOS we reached two patients with good recovery, 2 patients with moderate disability, 5 patients with severe disability and 2 patients died.

    Conclusions: In case we confirm the correlation between PbtO2 and TCD measurement, the PbtO2 monitoring could be a complementary method for early detection of vasospasms due to its continuous nature. The research is supported by Internal Grant Agency of the Czech Ministry of Health No NT 11 092

    Patient Care: With early vasospasm detection the patients may reach a better outcome

    Learning Objectives: To get a new knowledge about the use of tissue oxymetry and CBF monitoring on sever SAH patients.

    References:

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