Mismatch between Tissue Partial Oxygen Pressure and Near-Infrared Spectroscopy Neuromonitoring of Tissue Respiration in Acute Brain Trauma: The Rationale for Implementing a Multimodal Monitoring Strategy
Abstract
:1. Introduction
2. Tissue Respiration
2.1. Physiological Tissue Respiration
2.1.1. Oxygen Forms in the Blood and Oxygen Diffusion
2.1.2. Hemoglobin and Oxygen–Hemoglobin Dissociation Curve
2.1.3. Partial Oxygen Pressure Gradients in the Microcirculation and Interstitial Tissue
2.1.4. Roles of the Fåhraeus Effect and Glycocalyx Layer in Oxygen Diffusion in the Microcirculation
2.1.4.1. Reduction in Hematocrit Along the Microcirculation
2.1.4.2. Plasma Gap
2.1.5. Cerebral Blood Flow Autoregulation
2.1.6. Vascular Tone of the Microcirculation According to the Tissue Metabolic Status
2.2. Tissue Respiration in Traumatic Brain Injury
2.2.1. Reduction of Circulatory Oxygen Delivery Capacity
2.2.1.1. Reduction of Cerebral Blood Flow
2.2.1.2. Reduction of Hematocrit
2.2.1.3. Response to Therapeutic Hyperoxia
2.2.2. Metabolic Dysfunction
2.2.3. Microcirculatory Dysfunction
2.2.3.1. Anatomical Damage to the Vessels in the Microcirculation
2.2.3.2. Reduction of Vascular Density in the Microcirculation
2.2.4. Abnormalities in Cerebrovascular Regulation
2.2.5. Cerebral Vasospasm
2.2.6. Abnormalities in the Microcirculatory Reactivity to the Metabolic Status
2.2.7. Fåhraeus Effect and the Role of Endotheliopathy in Brain Trauma Microcirculation
2.2.8. Shifts in the Oxygen–Hemoglobin Dissociation Curve in the Tissue Microcirculation
2.2.8.1. Hydrogen Concentration
2.2.8.2. Carbon Dioxide Concentration
2.2.8.3. 2,3-Diphosphoglycerate Concentration
2.2.8.4. Chloride Concentration
2.2.8.5. Temperature
3. Intracranial Tissue Partial Oxygen Pressure and Near-Infrared Spectroscopy Neuromonitoring in Acute Traumatic Brain Injury
3.1. Inability to Infer the Whole Pathological Tissue Respiration Status by Analysis of Tissue Partial Oxygen Pressure Alone
3.1.1. The Interstitial Tissue Partial Oxygen Pressure Neuromonitoring Does Not Respond to All Pathological Abnormalities in Tissue Respiration
3.1.2. The Interstitial Tissue Partial Oxygen Pressure Is an Average of Different Pathogenetic Mechanisms Related to Brain Trauma
3.2. The Intracranial Tissue Partial Oxygen Pressure and Near-Infrared Spectroscopy Neuromonitoring Can Be Affected Differently by the Brain Trauma Pathogenesis
3.2.1. Metabolic Dysfunction
3.2.2. Reduction in Oxygen Diffusion and Oxygen‑Carrying Capacity
3.2.3. Right-Shift of the Oxygen–Hemoglobin Dissociation Curve
3.3. Different Volumes and Statuses Are Analyzed by the Tissue Partial Oxygen Pressure and Near-Infrared Spectroscopy Neuromonitoring
3.3.1. Different Tissue Statuses Across the Brain Can Influence the Values Reported
3.3.2. Changes in the Volumes Examined
3.4. Heterogeneity of Values within the Volume Analyzed by the Tissue Partial Oxygen Pressure and Near‑Infrared Spectroscopy Neuromonitoring
3.4.1. Tissue Partial Oxygen Pressure Neuromonitoring
3.4.2. Near-Infrared Spectroscopy Neuromonitoring
3.5. Barriers to Accurate Data Acquisition Using Tissue Partial Oxygen Pressure and Near-Infrared Spectroscopy Neuromonitoring
3.5.1. Tissue Partial Oxygen Pressure Neuromonitoring
3.5.2. Near-Infrared Spectroscopy Neuromonitoring
4. Future Application of Tissue Partial Oxygen Pressure and Near-Infrared Spectroscopy Neuromonitoring in Clinical Practice
4.1. Biosignatures
4.2. Multimodal Monitoring
4.2.1. Tissue Partial Oxygen Pressure and Near-Infrared Spectroscopy Neuromonitoring
4.2.1.1. Different Types of Near-Infrared Spectroscopy
- Absolute and Relative Values of Tissue Saturation
4.2.1.2. Contrast-Enhanced Near-Infrared Spectroscopy
4.2.1.3. Diffuse Optical Tomography
4.2.2. Computerized Tomography and Magnetic Resonance Imaging
4.2.3. Microdialysis
4.2.4. Mean Arterial Pressure and Intracranial Pressure Monitoring
4.2.5. Arterial Blood Gas Analysis
4.2.6. Blood Sampling
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ABG | Arterial blood gas analysis |
2,3-DPG | 2,3-Diphosphoglycerate |
SD | Source-detector |
CT | Computerized tomography |
ICP | Intracranial pressure |
CO2 | Carbon dioxide |
ARDS | Acute respiratory distress syndrome |
DOT | Diffuse optical tomography |
CBF | Cerebral blood flow |
CPP | Cerebral perfusion pressure |
ECT | Extracranial tissue |
Hb | Hemoglobin |
HHb | Deoxyhemoglobin |
ICG | Indocyanine green |
FEM | Finite-element method |
MAP | Mean arterial pressure |
MRI | Magnetic resonance imaging |
NIRS | Near-infrared spectroscopy |
NO | Nitric oxide |
BBB | Blood–brain barrier |
O2 | Oxygen |
O2Hb | Oxyhemoglobin |
PaO2 | Arterial partial oxygen pressure |
PbtO2 | Tissue partial oxygen pressure |
SIADH | Syndrome of inappropriate antidiuretic hormone secretion |
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Type | Time | Region Monitored | Parameters |
---|---|---|---|
PbtO2 1 monitor | Continuous | Brain | PbtO2 |
NIRS 2 | Continuous | Brain | O2Hb 3, HHb 4 |
Contrast-enhanced NIRS | Intermittent | Brain | ICG 5 |
CT 6 head | Intermittent | Brain | Structural injuries |
MRI 7 head | Intermittent | Brain | Structural injuries |
Microdialysis | Intermittent | Brain | Lactate/pyruvate ratio |
Arterial cannulation | Continuous | Systemic | MAP 8 |
ICP 9 monitor | Continuous | Brain | ICP |
ABG 10 | Intermittent | Systemic | Arterial pH, anion gap |
Blood sample | Intermittent | Systemic | Hematocrit, electrolytes, plasma proteins, 2,3-DPG 11 |
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Forcione, M.; Ganau, M.; Prisco, L.; Chiarelli, A.M.; Bellelli, A.; Belli, A.; Davies, D.J. Mismatch between Tissue Partial Oxygen Pressure and Near-Infrared Spectroscopy Neuromonitoring of Tissue Respiration in Acute Brain Trauma: The Rationale for Implementing a Multimodal Monitoring Strategy. Int. J. Mol. Sci. 2021, 22, 1122. https://doi.org/10.3390/ijms22031122
Forcione M, Ganau M, Prisco L, Chiarelli AM, Bellelli A, Belli A, Davies DJ. Mismatch between Tissue Partial Oxygen Pressure and Near-Infrared Spectroscopy Neuromonitoring of Tissue Respiration in Acute Brain Trauma: The Rationale for Implementing a Multimodal Monitoring Strategy. International Journal of Molecular Sciences. 2021; 22(3):1122. https://doi.org/10.3390/ijms22031122
Chicago/Turabian StyleForcione, Mario, Mario Ganau, Lara Prisco, Antonio Maria Chiarelli, Andrea Bellelli, Antonio Belli, and David James Davies. 2021. "Mismatch between Tissue Partial Oxygen Pressure and Near-Infrared Spectroscopy Neuromonitoring of Tissue Respiration in Acute Brain Trauma: The Rationale for Implementing a Multimodal Monitoring Strategy" International Journal of Molecular Sciences 22, no. 3: 1122. https://doi.org/10.3390/ijms22031122