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Published on: November 19, 2020
Continuous brain tissue oxygenation monitoring in the management of pediatric stroke
Baxter B Allen1, Caitlin E Hoffman, Chani S Traube
1Division of Child Neurology, Department of Pediatrics, Weill Cornell Medical College, New York 10065, USA.
Insights
Brain tissue oxygen monitoring (PbtO(2)) shows promise in pediatric stroke patients, detecting low oxygen events and potentially preventing further ischemic damage. Further research is needed to confirm its utility in this population.
Area of Science:
- Pediatric Critical Care Medicine
- Neurocritical Care
- Cerebral Ischemia Monitoring
Background:
- Direct invasive monitoring of brain tissue oxygenation (PbtO(2)) is standard for TBI and SAH to predict and prevent cerebral ischemia.
- Limited data exists on PbtO(2) monitoring safety and utility in pediatric populations.
- No prior studies have investigated PbtO(2) monitoring in pediatric stroke patients.
Observation:
- This study reviewed two critically ill pediatric stroke patients requiring PbtO(2) monitoring.
- Continuous monitoring of ICP, CPP, PbtO(2), SaO(2), BP, and RR was performed.
- Retrospective data collection and analysis were conducted.
Findings:
- PbtO(2) monitoring identified multiple instances of low brain tissue oxygen (<20 torr) in both pediatric stroke patients.
- These low PbtO(2) events were independent of other monitored parameters (ICP, CPP, SaO(2)).
- Physician intervention was prompted by low PbtO(2) values, and no new ischemic damage occurred post-monitoring initiation.
Implications:
- Current data is insufficient to establish PbtO(2) monitoring for preventing progressive ischemia or improving outcomes in pediatric stroke.
- The positive outcomes in these two cases suggest PbtO(2) monitoring warrants further investigation in pediatric stroke.
- This approach may offer a valuable tool for managing cerebral ischemia in pediatric stroke patients.
Background:
Direct invasive monitoring of brain tissue oxygenation (PbtO(2)) has been routinely utilized to predict cerebral ischemia and to prevent secondary injury in patients with traumatic brain injury (TBI) and vasospasm secondary to subarachnoid hemorrhage (SAH). The safety and utility of these devices in the pediatric population have been examined in a few small studies. No studies, however, have examined the use of PbtO(2) monitoring in stroke patients.
Methods:
Retrospective chart review of the first two consecutive, critically ill pediatric patients in the pediatric intensive care unit requiring brain tissue oxygen monitoring for newly diagnosed cerebral ischemia. ICP, CPP, PbtO(2), SaO(2), BP, and RR were all continually monitored during their care and were retrospectively collected and reviewed.
Results:
We present two pediatric stroke patients managed in a critical care setting with PbtO(2) monitoring in addition to ICP, MAP, CPP, and SaO(2). Both patients had multiple events of low brain tissue oxygen (PbtO(2) <20 torr), independent of abnormal values in other monitoring parameters, which required physician intervention. No new ischemic damage occurred after PbtO(2) monitoring began in either patient.
Conclusions:
There is currently inadequate data to support the application of PbtO(2) monitoring in children with stroke to prevent progressive ischemia and to improve outcome. However, the positive results for these two patients support the need for further study in this area.
