NIR - New Research tool for hypovolemia & Vasopressors, etc.

[IVAN HRONEK]

Near-Infrared Spectroscopy: Potential Clinical Benefits in Surgery
Journal of the American College of Surgeons - Volume 205, Issue 2 (August 2007)  -  Copyright © 2007 American College of Surgeons 
 
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Multimodality monitoring in severe traumatic brain injury: the role of brain tissue oxygenation monitoring.Mulvey JM - Neurocrit Care - 01-JAN-2004; 1(3): 391-402
 
Traumatic brain injury (TBI) is a major cause of morbidity and mortality with widespread social, personal, and financial implications for those who survive. TBI is caused by four main events: motor vehicle accidents, sporting injuries, falls, and assaults. Similarly to international statistics, annual incidence reports for TBI in Australia are between 100 and 288 per 100,000. Regardless of the cause of TBI, molecular and cellular derangements occur that can lead to neuronal cell death. Axonal transport disruption, ionic disruption, reduced energy formation, glutamate excitotoxicity, and free radical formation all contribute to the complex pathophysiological process of TBI-related neuronal death. Targeted pharmacological therapy has not proved beneficial in improving patient outcome, and monitoring and maintenance of various physiological parameters is the mainstay of current therapy. Parameters monitored include arterial blood pressure, blood gases, intracranial pressure, cerebral perfusion pressure, cerebral blood flow, and direct brain tissue oxygen measurement (ptiO2). Currently, indirect brain oximetry is used for cerebral oxygenation determination, which provides some information regarding global oxygenation levels. A newly developed oximetry technique, has shown promising results for the early detection of cerebral ischemia. ptiO2 monitoring provides a safe, easy, and sensitive method of regional brain oximetry, providing a greater understanding of neurophysiological derangements and the potential for correcting abnormal oxygenation earlier, thus improving patient outcome. This article reviews the current status of bedside monitoring for patients with TBI and considers whether ptiO2 has a role in the modern intensive care setting.
Ivan Hronek MDChief, Critical Care & Trauma AnesthesiaSFMC Gas, Inc.St. Francis Medical Center3630 E. Imperial HighwayLynwood, CA 90262 Cell: 310 487-3288Pager: 310 636-6020



> From: KMATTOX at aol.com> Date: Sun, 5 Aug 2007 18:13:17 -0400> To: trauma-list at trauma.org> Subject: NIR - New Research tool for hypovolemia & Vasopressors, etc. > > > In a message dated 8/5/2007 5:02:24 P.M. Central Daylight Time, ih7 at msn.com > writes:> > We're specifically interested in doing research in this area, perhaps > starting with case studies using pressors,> and the TBI pts. might be the best to start with due to what K is saying in > his email: > > this of course contradicts the "no vasopressors in hypovolemic patient " > dogma.> > > > This is a PERFECT area for NIR as a monitoring tool for an end point of > perfusion and oxygen consumption, IF THE PROBES went deep enough into the brain > to measure the continuing oxygen extraction and perfusion. > > It is my view that we have bowed to the shrine of the BP as an end point and > resuscitation measure for FAR TOO LONG. It has been members of this > list server that have led the world in putting the sphygmomanometer into the > curiosity section of the Medical Museum. Karim, I can see a corner of the > Hunter Museum at the Royal College of Surgeons in about 5 years having a display > of the sphygmomanometer with a card to explain to those viewing this archaic > instrument as something which mislead generations of physicians, nurses and > patients. > > k> > > > ************************************** Get a sneak peek of the all-new AOL at > http://discover.aol.com/memed/aolcom30tour> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/
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