Determination of the Ischemic Threshold for Brain Oxygen Tension

Abstract

Measuring brain tissue oxygenation is now possible due to major advances in the technical development of Clark-electrodes and fiberoptic systems. However, to make this technique clinically useful for both nurses and medical staff, the ischemic threshold for brain tissue oxygen tension (brain pO2) must be determined. Three end points were used for determination of the critical brain pO2 value. 1) Infarct determination after permanent middle cerebral artery occlusion in a feline model. 2) Threshold analysis using the schemic threshold for cerebral blood flow (CBF) as a "gold standard" in severely head injury patients. 3) Outcome analysis in severely head injured patients. Brain pO2 dropped to 19±6mmHg and 23 ± 6, 4 to 5 hours after MCA occlusion in the cat (n = 12). In severely head injured patients, a brain pO2 ≤ 19mmHg was correlated with poor outcome (n = 24). The ischemic threshold for (r)CBF of 18ml/100g/min corresponded to a brain pO2 of 22mmHg, in the same patients. By using the above mentioned end points as a reference, we found the critical value for brain pO2 to be in between 19 and 23mmHg. Clearly, the difference between our threshold value and the lower critical brain pO2 level found by other groups using the Licox system, needs to be clarified in a comparison study before a uniform threshold for brain pO2 can be determined.