Journal
BRITISH JOURNAL OF ANAESTHESIA
Volume 108, Issue 1, Pages 89-99Publisher
ELSEVIER SCI LTD
DOI: 10.1093/bja/aer324
Keywords
brain tissue partial oxygen pressure; cerebral haemodynamics; cerebral oxygenation; cerebrovascular reactivity; near-infrared spectroscopy; tissue haemoglobin index; tissue oxygenation index
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Funding
- National Institute of Health Research, Biomedical Research Centre
- National Institute of Health
- Clifford and Mary Corbridge Trust of Robinson College, Cambridge, UK
- Swiss National Science Foundation [PBBSP3-125550]
- Foundation for Polish Science
- Hamamatsu Photonics, Hertfordshire, UK
- MRC [G0001237, G0600986, G9439390] Funding Source: UKRI
- Swiss National Science Foundation (SNF) [PBBSP3-125550] Funding Source: Swiss National Science Foundation (SNF)
- Medical Research Council [G0600986, G0001354, G1000183B, G0001354B, G0001237, G9439390] Funding Source: researchfish
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Background. Brain tissue partial oxygen pressure (Pbt(O2)) and near-infrared spectroscopy (NIRS) are novel methods to evaluate cerebral oxygenation. We studied the response patterns of Pbt(O2), NIRS, and cerebral blood flow velocity (CBFV) to changes in arterial pressure (AP) and intracranial pressure (ICP). Methods. Digital recordings of multimodal brain monitoring from 42 head-injured patients were retrospectively analysed. Response latencies and patterns of Pbt(O2), NIRS-derived parameters [tissue oxygenation index (TOI) and total haemoglobin index (THI)], and CBFV reactions to fluctuations of AP and ICP were studied. Results. One hundred and twenty-one events were identified. In reaction to alterations of AP, ICP reacted first [4.3 s; inter-quartile range (IQR) -4.9 to 22.0 s, followed by NIRS-derived parameters and CBFV (10.9 s; IQR: -5.9 to 39.6 s, 12.1 s; IQR: -3.0 to 49.1 s, 14.7 s; IQR: -8.8 to 52.3 s for THI, CBFV, and TOI, respectively), with Pbt(O2) reacting last (39.6 s; IQR: 16.4 to 66.0 s). The differences in reaction time between NIRS parameters and Pbt(O2) were significant (P < 0.001). Similarly when reactions to ICP changes were analysed, NIRS parameters preceded Pbt(O2) (7.1 s; IQR: -8.8 to 195.0 s, 18.1 s; IQR: -20.6 to 80.7 s, 22.9 s; IQR: 11.0 to 53.0 s for THI, TOI, and Pbt(O2), respectively). Two main patterns of responses to AP changes were identified. With preserved cerebrovascular reactivity, TOI and Pbt(O2) followed the direction of AP. With impaired cerebrovascular reactivity, TOI and Pbt(O2) decreased while AP and ICP increased. In 77% of events, the direction of TOI changes was concordant with Pbt(O2). Conclusions. NIRS and transcranial Doppler signals reacted first to AP and ICP changes. The reaction of Pbt(O2) is delayed. The results imply that the analysed modalities monitor different stages of cerebral oxygenation.
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