Cerebral oxygenation in the traumatically brain-injured patient: are ICP and CPP enough?

Secondary brain injury results in increased morbidity and mortality in the traumatically brain-injured (TBI) patient. Research has shown that prevention of secondary brain injury, as characterized by cerebral ischemia and edema, can improve neurologic outcomes. The standard of care in many facilities is to monitor intracranial pressure and cerebral perfusion pressure as indirect measures of cerebral oxygenation and perfusion and to therefore manage secondary brain injury via these parameters. Yet these may not be the most accurate or reliable measures of cerebral oxygenation. Scientifically, brain tissue oxygenation can be directly measured via the partial pressure of oxygen in brain tissue (PbO2) probe. This provides a rapid, potentially more accurate indicator of cerebral oxygenation, thereby allowing for earlier intervention into the prevention of secondary brain injury.