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Journal of critical care · Jun 2023
ReviewAvoiding brain hypoxia in severe traumatic brain injury in settings with limited resources - A pathophysiological guide.
- Daniel Agustin Godoy, Andres M Rubiano, Jorge Paranhos, Chiara Robba, and Christos Lazaridis.
- Critical Care Department, Neurointensive Care Unit, Sanatorio Pasteur, Catamarca, Argentina. Electronic address: dagodoytorres@yahoo.com.ar.
- J Crit Care. 2023 Jun 1; 75: 154260154260.
AbstractCerebral oxygenation represents the balance between oxygen delivery, consumption and utilization by the brain, and therefore reflects the adequacy of cerebral perfusion. Different factors can influence the amount of oxygen to the brain including arterial blood pressure, hemoglobin levels, systemic oxygenation, and transfer of oxygen from blood to the cerebral microcirculation. A mismatch between cerebral oxygen supply and demand results in cerebral hypoxia/ischemia, and is associated with secondary brain damage and worsened outcome after acute brain injury. Therefore, monitoring and prompt treatment of cerebral oxygenation compromise is warranted in both neuro and general intensive care unit populations. Several tools have been proposed for the assessment of cerebral oxygenation, including non-invasive/invasive or indirect/direct methods, including Jugular Venous Oxygen Saturation (SjO2), Partial Brain Tissue Oxygen Tension (PtiO2), Near infrared spectroscopy (NIRS), Transcranial Doppler, electroencephalography and Computed Tomography. In this manuscript, we aim to review the pathophysiology of cerebral oxygenation, describe monitoring technics, and generate recommendations for avoiding brain hypoxia in settings with low availability of resources for direct brain oxygen monitoring.Copyright © 2023 Elsevier Inc. All rights reserved.
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