Brain Tissue Oxygen Monitoring

Licox Device

Investigators have proposed the prognostic value of monitoring brain tissue oxygenation (Pbt^2) in the setting of TBI (21,29a). The goal of monitoring Pbt^2 is to provide additional information about the local cerebral perfusion of injured cerebral tissue.

The patient is prepared in a similar fashion as in the insertion of the ICP monitor described above. The standard insertion site at Kocher's point may be used, or the surgeon may choose to aim the probe toward a specific tissue in question. pbtO2 monitors such as the Licox (Integra NeuroSciences) are commercially available. To begin, the drill stop on the drill bit is adjusted to penetrate the skull. A small incision is made, and a burr hole is made with the twist drill. The dura is then incised with a #11 scalpel. The bolt is twisted into the hole (Fig. 4A). Subsequent insertion of the stylet through the bolt ensures an adequate dural opening.

An introducer with three ports (ICP, oxygen, and temperature) is inserted through the bolt, and the compression screw is loosely fastened around it (Fig. 4B). The ICP transducer, or Camino, is calibrated as described above and inserted through the appropriate port of the introducer in lieu of its obturator. The ICP tracing can be visualized on the monitor to ensure placement in the subarachnoid space or parenchymal surface. The depth of the Camino catheter is adjusted by pulling the white plastic sleeve until the black ring is visible (Fig. 4C). The catheter is then secured by tightening the adjacent compressor cap. The oxygen and temperature probes are then inserted in the remaining ports and secured with a Luer lock system (Fig. 4D). Finally, the compression cap at the bolt is secured to contain the sterile entry point. Dressing, as with the ICP monitor, is sterile gauze wrapped around the insertion site and soaked with povidone-iodine solution. The temperature and oxygen probes are attached to

Icp Bolt And Oxygen

Fig. 4. Insertion of a Licox (Integra NeuroSciences) monitor. (A) The bolt is screwed into a burr hole. (B) An introducer with three ports (ICP, oxygen, and temperature) is inserted through the bolt and the compression screw is loosely fastened around it. The Camino transducer is zeroed and placed in the appropriate port. Its depth is adjusted by pulling to expose the black ring (C) and tightening the adjacent compressor cap. (D) Oxygen and temperature probes are placed in the remaining ports. (E) Colorcoded cables attach these probes to the monitor (F).

Fig. 4. Insertion of a Licox (Integra NeuroSciences) monitor. (A) The bolt is screwed into a burr hole. (B) An introducer with three ports (ICP, oxygen, and temperature) is inserted through the bolt and the compression screw is loosely fastened around it. The Camino transducer is zeroed and placed in the appropriate port. Its depth is adjusted by pulling to expose the black ring (C) and tightening the adjacent compressor cap. (D) Oxygen and temperature probes are placed in the remaining ports. (E) Colorcoded cables attach these probes to the monitor (F).

their appropriate cables, which are then connected to the monitor. With the Licox, the monitor is calibrated by inserting a card that is packaged with the probes (Fig. 4F).

Codman Device

The Codman device is a solid-state parenchymal monitor used in trauma centers. The cable is more pliable than the Camino fiberoptic parenchymal device.

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