CS351
The GOOD Oxygen, the BAD Brain and the UGLY Hypoxia
By: S. Reize, S. Livesay, S. Styron, M. Mokracek, & E. Angeles & A. Agudelo; St. Luke's Episcopal Hospital; TX
For further information, please contact: SReize@sleh.com
Purpose: Brain tissue oxygenation monitoring (PbtO2) is standard in Traumatic Brain Injury patients and has recently been applied to stroke patients. Our neuroscience team decided to pursue a trial of the PbtO2 equipment to aid in the early detection of cerebral hypoxia in stroke patients.
Description: A multidisciplinary team including staff nurses, advanced practice nurses, clinical pharmacists and a Neurointensivist reviewed the literature and developed a pilot protocol to evaluate the usefulness of PbtO2 monitoring in the hemorrhagic stroke patient. The literature review demonstrated that trending the differences between brain tissue oxygen supply and demand, may detect ischemia and guide interventions in the management of stroke. Trial equipment (Licox brain tissue oxygen monitoring system) was acquired and the nurses and physicians were trained on the use of the system. A protocol was developed to guide patient treatment and improve neurological outcomes. The protocol included criteria to initiate the PbtO2 system, location of bolt placement, goal of monitoring, management of cerebral hypoxia, ICP and CPP, nursing monitoring and catheter management. PbtO2 catheters were placed on 5 SAH and ICH patients. When the system was placed appropriately, the neuroscience team observed that the monitoring indicated cerebral ischemia and hypoperfusion prior to clinical signs and symptoms. Early interventions were then made based on monitoring.
Evaluation/Outcomes: During the pilot phase, 5 patients received PbtO2 monitoring. Summary of the patients and a case study will be provided. Nursing and medical interventions were titrated to PbtO2 on all 5 patients. As a result of the pilot, the decision was made to purchase the equipment and offer this monitoring to all hemorrhagic stroke patients.
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