Možnosti kontinuálního monitoringu ptiO2 a CBF a jejich korelace s TCD v detekci vazos pásmu u pacientů po těžkém SAK - závěrečná zpráva
| Title in English | The possibilities of continuous monitoring of PtiO2 and CBF and their correlation with TCD in the detection of vasospasm in patients after severe SAH - Final Report |
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| Authors | |
| Year of publication | 2013 |
| Type | Conference abstract |
| MU Faculty or unit | |
| Citation | |
| Description | The aim of the study was to compare the data from brain tissue oxygen monitoring (PtiO2 system Licox) and cerebral blood flow monitoring (CBF system Hemedex) in patients with severe subarachnoid hemorrhage (SAH). A further aim was to evaluate whether there is a correlation between TCD parameters and values of PtiO2 or CBF monitoring. Patients with aneurismal SAH from cerebral artery in clinical status and NH4 and HH5 were enrolled into the study. All diagnostic and therapeutic procedures were managed in a standard way. PtiO2 and CBF monitoring was performed, optimally, between the 4th and 14 days, to cover the period of greatest risk of cerebral vasospasm. TCD examination was performed repeatedly during this period. Correlation between PtiO2 and CBF as well as the correlation between several TCD parameters (PSV, EDV, Vmean, PI and RI) and PtiO2 or CBF were evaluated. In total 56 patients were enrolled into the study, of which 17 patients were subsequently excluded because of poor positioning or early malfunction of the probe. The evaluated group of 39 patients was divided into two groups in order to find out the potential impact of CBF monitoring on PbtO2 measurement. In the first group (17 patients) parallel monitoring of PbtO2 and CBF was used, while the second group (22 patients) received only PbtO2 monitoring. The clinical characteristics were comparable between groups, as well as PbtO2 values. Positive correlation (higher blood flow - higher levels of oxygen in the tissue) was significant in the case of 10 patients, while the paradoxical correlation (higher blood flow -lower oxygen levels in the tissue) was present in case of 3 patients. There was no significant correlation between CBF and PbtO2 in case of the remaining four patients. There was significant correlation between PbtO2 and PI (r = -0.4077, p = 0.0074) as well as RI (r = -0.4055, p = 0.0077) in the evaluated group. There was no significant correlation between all other TCD parameters (PSV, EDV, V mean) and PbtO2. There was also no significant correlation of CBF with any of TCD parameters. We found a significant correlation of PbtO2 with PI and RI. While the PI reflects intracranial pressure, RI reflects the micro vascular resistivity. The correlation between the above-described indexes and PbtO2 shows the connection between PbtO2 and micro vessels, while no connection between the flow rates of main arteries and PbtO2 was demonstrated. The lack of correlation between TCD and CBF, as well as conflicting results of correlation between PtiO2 and CBF suggest that the use of the Hemedex system in clinical practice is still very limited in case of SAH patients. |