Innovations in the management of cerebral injury

During the past decade, brain tissue oxygen monitoring has been studied predominantly in Europe. Cerebral oxygenation monitoring was implemented in many intensive care units and correlations of intracranial pressure, cerebral perfusion pressure, end-tidal carbon dioxide monitoring, fever and partial pressure of brain tissue oxygenation (Pbto2) have been described (Crit Care Nurse. 2003;23[4, pt 1]:17-27). The monitoring of brain tissue oxygen is now being done and researched in the United States. This article will discuss the history of treatment of traumatic brain injury and how treatment interventions are changing with the latest technological advances in monitoring of cerebral oxygen levels and suggested interventions and factors that affect brain tissue oxygenation. It is clear that by understanding the causes of hypoxia and ischemia--along with the interventions to treat them--the critical care team will be better able to prevent low oxygen states in the brain and optimize treatment, thus improving patient outcome.