Clinical DIND Reports

Delayed Ischemic Neurological Deficit and Trauma
Clinical Reports and Abstracts

This section is intended to provide you clinical reports for the INVOS Cerebral Oximeter.
We will update this section with abstracts and other Clinical Reports, as they become available.

A link to the document is provided when available. These links may take you to
another site such as PubMed.

Delayed Ischemic Neurological Deficit and Trauma

Dunham CM, Ransom KJ, Flowers LL, Siegal JD, Kohli DM. Cerebral hypoxia in severely
brain-injured patients is associated with admission Glasgow Coma Scale score, computed
tomographic severity, cerebral perfusion pressure, and survival. J Trauma 2004;56:482-491.
[Abstract] [PubMed]

Armonda RA, Benitiz R, Forget T, Thomas JE, Rosenwasser RH. Combined cerebral oximetry
and transcranial Doppler for vasospasm detection. Presented at the AANS/CNS Section on
Cerebrovascular Surgery, Waikoloa, Hawaii, February 9-12, 2001, Article ID: 14206.* [Abstract]

Armonda RA, Noonan P, Naff N, Benitiz R, Rosenwasser RH. Test balloon occlusion using
near-infrared cerebral oximetry. Presented at the AANS/CNS Section on Cerebrovascular
Surgery, Waikoloa, Hawaii, February 9-12, 2001, Article ID: 14231.* [Abstract]

Armonda RA, McGee B, Veznadaraglu E, Forget T, Thomas JE, Rosenwasser RH. Monitoring
cerebral oximetry in the management of pulmonary insufficiency in aneurismal SAH. Presented
at the American Association of Neurological Surgeons, San Francisco, CA, April 10-12, 2000,
Article ID: 15281.* [Abstract]

Armonda RA, McGee W, Veznadaraglu E, Shanno G, Thomas JE, Rosenwasser RH. Cerebral
vasospasm detection and monitoring intervention using combined cerebral oximetry and
transcranial Doppler. Presented at the American Association of Neurological Surgeons,
San Francisco, CA, April 10-12, 2000, Article ID: 15313.* [Abstract]

Kerr ME, Mario D, Sereika SM, Weber BB, Orndoff PA, Henker R, Wilberger J. The effect of
cerebrospinal fluid drainage on cerebral perfusion in traumatic brain injured adults. J Neurosurg
Anesthesiol. 2000;12:324-333. [Abstract] [PubMed]

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J Trauma. 2004 Mar;56(3):482-9; discussion 489-91.

Cerebral hypoxia in severely brain-injured patients is associated
with admission Glasgow Coma Scale score, computed tomographic
severity, cerebral perfusion pressure, and survival.

Dunham CM, Ransom KJ, Flowers LL, Siegal JD, Kohli CM.

Trauma/Critical Care Services, St. Elizabeth Health Center, 1044 Belmont
Avenue, Youngstown, OH 44501, USA.

BACKGROUND: The purpose of this study was to determine the relationship of
cerebral hypoxia with admission Glasgow Coma Scale (GCS) score, brain
computed tomographic (CT) severity, cerebral perfusion pressure (CPP), and
survival in patients with severe brain injury. METHODS: CPP and noninvasive
transcranial oximetry (Stco2) were recorded hourly for 6 days in patients with a
GCS score < or = 8 (3,722 observations). CT score was derived from midline shift
(0/1) plus abnormal cisterns (0/1) plus subarachnoid hemorrhage (SAH) (0/1)
(range, 0-3). RESULTS: Brain CT results were as follows: shift, 10 (56%);
abnormal cisterns, 14 (78%); SAH, 9 (50%); epidural hematoma, 2 (11%);
subdural hematoma, 11 (61%); and contusion, 17 (94%). The incidences of Stco2
< 60 were: GCS score 3-4, 26.5%; GCS score 5-7, 12.4%; and GCS score 8, 2.8%
(p < 0.0001); CT score 2/3, 26.4%; and CT score 0/1, 10.0% (p < 0.0001);
nonsurvivors 36.1%; and survivors 16.3% (p < 0.0001). For incidence of CPP
< 70, the results were as follows: Stco2 < 60%, 33% of observations; Stco2 > or
= 60%, 10% of observations (odds ratio, 4.3; p < 0.01). Despite CPP > or = 70,
Stco2 < 60 incidence was 16% of observations. CONCLUSION: Cerebral
hypoxia is common, even with CPP > or = 70, and is associated with GCS score,
CT scan severity, and mortality. Cerebral hypoxia is related to cerebral
hypoperfusion. Additional studies may prove that Stco2 monitoring will enhance
the treatment of severe brain injury.

PMID: 15128117 [PubMed - indexed for MEDLINE]

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Neurosurg Anesthesiol. 2000 Oct;12(4):324-33.

The effect of cerebrospinal fluid drainage on cerebral perfusion in
traumatic brain injured adults.

Kerr EM, Marion D, Sereika MS, Weber BB, Orndoff AP, Henker R,
Wilberger J.

University of Pittsburgh School of Nursing, Pennsylvania 15213, USA.

Cerebrospinal fluid drainage is a first line treatment used to manage severely
elevated intracranial pressure (> or = 20 mm Hg) and improve outcomes in
patients with acute head injury. There is no consensus regarding the optimal
method of cerebrospinal fluid removal. The purpose of this investigation was to
determine whether cerebrospinal fluid drainage decreases intracranial pressure
and improves cerebral perfusion and to identify factors that impact treatment
effectiveness. This study involved 31 severely head injured patients. Intracranial
pressure and other indices of cerebral perfusion (cerebral perfusion pressure,
cerebral blood flow velocity, and regional cerebral oximetry) were measured
before, during, and after cerebrospinal fluid drainage. Arterial and jugular venous
oxygen content was measured before and after cerebrospinal fluid drainage.
Patients underwent three randomly ordered cerebrospinal fluid drainage protocols
that varied in the volume of cerebrospinal fluid removed (1 mL, 2 mL, and 3 mL)
for a total of 6 mL of cerebrospinal fluid removed. There was a significant change
in the intracranial pressure from a mean at baseline of 26.1 mm Hg (SD = 4.4) to
22.1 mm Hg immediately after drainage. One third of patients experienced a
decrease in the intracranial pressure below 20 mm Hg; in two patients the
intracranial pressure dropped less than 1 mm Hg. The following factors predicted
61.5% of the variance in the responsiveness of intracranial pressure to drainage:
vecuronium hypothermia, baseline cerebral perfusion pressure and acuity of
illness. Cerebrospinal fluid drainage provides a transient decrease in intracranial
pressure without a measurable improvement in other indices of cerebral perfusion.

PMID: 11147381 [PubMed - indexed for MEDLINE]

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