Individualized Brain Tissue Oxygen-Monitoring Probe Placement Helps to Guide Therapy and Optimizes Outcome in Neurocritical Care

Levin Häni; Mario D Ropelato; Franca Wagner; Andreas Nowacki; Nicole Söll; Matthias Haenggi; Andreas Raabe; Werner J Z'Graggen

doi:10.1007/s12028-020-01171-3

Individualized Brain Tissue Oxygen-Monitoring Probe Placement Helps to Guide Therapy and Optimizes Outcome in Neurocritical Care

Neurocrit Care. 2021 Aug;35(1):197-209. doi: 10.1007/s12028-020-01171-3. Epub 2020 Dec 16.

Authors

Levin Häni¹, Mario D Ropelato², Franca Wagner³, Andreas Nowacki², Nicole Söll², Matthias Haenggi⁴, Andreas Raabe², Werner J Z'Graggen²

Affiliations

¹ Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland. levin.haeni@insel.ch.
² Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
³ Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁴ Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

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 ptO₂ 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 ptO₂ 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.

Keywords: Brain hypoxia; Cerebral vasospasm; Subarachnoid hemorrhage; Traumatic brain injury.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain* / diagnostic imaging
Humans
Microsurgery
Monitoring, Physiologic
Oxygen*
Retrospective Studies

Substances

Oxygen