OBJECTIVE: To determine the effect of normobaric hyperoxia on cerebral metabolism in patients with severe traumatic brain injury. DESIGN: Prospective clinical investigation. SETTING: Neurosciences critical care unit of a university hospital. PATIENTS: Eleven patients with severe traumatic brain injury. INTERVENTIONS: Cerebral microdialysis, brain tissue oximetry (PbO2), and oxygen-15 positron emission tomography (15O-PET) were undertaken at normoxia and repeated at hyperoxia (FiO2 increase of between 0.35 and 0.50). MEASUREMENTS AND MAIN RESULTS: Established models were used to image cerebral blood flow, blood volume, oxygen metabolism, and oxygen extraction fraction. Physiology was characterized in a focal region of interest (surrounding the microdialysis catheter) and correlated with microdialysis and oximetry. Physiology was also characterized in a global region of interest (including the whole brain), and a physiologic region of interest (defined using a critical cerebral metabolic rate of oxygen threshold). Hyperoxia increased mean +/- sd PbO2 from 28 +/- 21 mm Hg to 57 +/- 47 mm Hg (p = .015). Microdialysate lactate and pyruvate were unchanged, but the lactate/pyruvate ratio showed a statistically significant reduction across the study population (34.1 +/- 9.5 vs. 32.5 +/- 9.0, p = .018). However, the magnitude of reduction was small, and its clinical significance doubtful. The focal region of interest and global 15O-PET variables were unchanged. "At-risk" tissue defined by the physiologic region of interest, however, showed a universal increase in cerebral metabolic rate of oxygen from a median (interquartile range) of 23 (22-25) micromol x 100 mL(-1) x min(-1) to 30 (28-36) micromol x 100 mL(-1) x min(-1) (p < .01). CONCLUSIONS: In severe traumatic brain injury, hyperoxia increases PbO2 with a variable effect on lactate and lactate/pyruvate ratio. Microdialysis does not, however, predict the universal increases in cerebral metabolic rate of oxygen in at-risk tissue, which imply preferential metabolic benefit with hyperoxia.
OBJECTIVE: To determine the effect of normobaric hyperoxia on cerebral metabolism in patients with severe traumatic brain injury. DESIGN: Prospective clinical investigation. SETTING: Neurosciences critical care unit of a university hospital. PATIENTS: Eleven patients with severe traumatic brain injury. INTERVENTIONS: Cerebral microdialysis, brain tissue oximetry (PbO2), and oxygen-15 positron emission tomography (15O-PET) were undertaken at normoxia and repeated at hyperoxia (FiO2 increase of between 0.35 and 0.50). MEASUREMENTS AND MAIN RESULTS: Established models were used to image cerebral blood flow, blood volume, oxygen metabolism, and oxygen extraction fraction. Physiology was characterized in a focal region of interest (surrounding the microdialysis catheter) and correlated with microdialysis and oximetry. Physiology was also characterized in a global region of interest (including the whole brain), and a physiologic region of interest (defined using a critical cerebral metabolic rate of oxygen threshold). Hyperoxia increased mean +/- sd PbO2 from 28 +/- 21 mm Hg to 57 +/- 47 mm Hg (p = .015). Microdialysate lactate and pyruvate were unchanged, but the lactate/pyruvate ratio showed a statistically significant reduction across the study population (34.1 +/- 9.5 vs. 32.5 +/- 9.0, p = .018). However, the magnitude of reduction was small, and its clinical significance doubtful. The focal region of interest and global 15O-PET variables were unchanged. "At-risk" tissue defined by the physiologic region of interest, however, showed a universal increase in cerebral metabolic rate of oxygen from a median (interquartile range) of 23 (22-25) micromol x 100 mL(-1) x min(-1) to 30 (28-36) micromol x 100 mL(-1) x min(-1) (p < .01). CONCLUSIONS: In severe traumatic brain injury, hyperoxia increases PbO2 with a variable effect on lactate and lactate/pyruvate ratio. Microdialysis does not, however, predict the universal increases in cerebral metabolic rate of oxygen in at-risk tissue, which imply preferential metabolic benefit with hyperoxia.
Authors: Franck Amyot; David B Arciniegas; Michael P Brazaitis; Kenneth C Curley; Ramon Diaz-Arrastia; Amir Gandjbakhche; Peter Herscovitch; Sidney R Hinds; Geoffrey T Manley; Anthony Pacifico; Alexander Razumovsky; Jason Riley; Wanda Salzer; Robert Shih; James G Smirniotopoulos; Derek Stocker Journal: J Neurotrauma Date: 2015-09-30 Impact factor: 5.269
Authors: Matthew J Sena; Ryan M Rivers; J Paul Muizelaar; Felix D Battistella; Garth H Utter Journal: Intensive Care Med Date: 2008-10-15 Impact factor: 17.440