Brain tissue oxygen tension and its response to physiological manipulations: influence of distance from injury site in a swine model of traumatic brain injury.
OBJECTIVE The optimal site for placement of tissue oxygen probes following traumatic brain injury (TBI) remains unresolved. The authors used a previously described swine model of focal TBI and studied brain tissue oxygen tension (PbtO2) at the sites of contusion, proximal and distal to contusion, and in the contralateral hemisphere to determine the effect of probe location on PbtO2 and to assess the effects of physiological interventions on PbtO2 at these different sites. METHODS A controlled cortical impact device was used to generate a focal lesion in the right frontal lobe in 12 anesthetized swine. PbtO2 was measured using Licox brain tissue oxygen probes placed at the site of contusion, in pericontusional tissue (proximal probe), in the right parietal region (distal probe), and in the contralateral hemisphere. PbtO2 was measured during normoxia, hyperoxia, hypoventilation, and hyperventilation. RESULTS Physiological interventions led to expected changes, including a large increase in partial pressure of oxygen in arterial blood with hyperoxia, increased intracranial pressure (ICP) with hypoventilation, and decreased ICP with hyperventilation. Importantly, PbtO2 decreased substantially with proximity to the focal injury (contusion and proximal probes), and this difference was maintained at different levels of fraction of inspired oxygen and partial pressure of carbon dioxide in arterial blood. In the distal and contralateral probes, hypoventilation and hyperventilation were associated with expected increased and decreased PbtO2 values, respectively. However, in the contusion and proximal probes, these effects were diminished, consistent with loss of cerebrovascular CO2 reactivity at and near the injury site. Similarly, hyperoxia led to the expected rise in PbtO2 only in the distal and contralateral probes, with little or no effect in the proximal and contusion probes, respectively. CONCLUSIONS PbtO2 measurements are strongly influenced by the distance from the site of focal injury. Physiological alterations, including hyperoxia, hyperventilation, and hypoventilation substantially affect PbtO2 values distal to the site of injury but have little effect in and around the site of contusion. Clinical interpretations of brain tissue oxygen measurements should take into account the spatial relation of probe position to the site of injury. The decision of where to place a brain tissue oxygen probe in TBI patients should also take these factors into consideration.
['Hawryluk|Gregory W J|GW|', 'Phan|Nicolas|N|', 'Ferguson|Adam R|AR|', 'Morabito|Diane|D|', 'Derugin|Nikita|N|', 'Stewart|Campbell L|CL|', 'Knudson|M Margaret|MM|', 'Manley|Geoffrey|G|', 'Rosenthal|Guy|G|']
D000818:Animals D001921:Brain D000070642:Brain Injuries, Traumatic D008297:Male D010100:Oxygen D013552:Swine
traumatic brain injury licox ABG = arterial blood gas CCI = controlled cortical impact CPP = cerebral perfusion pressure FiO2 = fraction of inspired oxygen GLM = general linear model ICP = intracranial pressure LMM = linear mixed model MAP = mean arterial pressure PaCO2 = partial pressure of carbon dioxide in arterial blood PaO2 = partial pressure of oxygen in arterial blood PbtO2 = brain tissue oxygen tension REML = restricted maximum likelihood modeling TBI = traumatic brain injury in vivo optimal location oxygen monitor