PbtO₂ monitoring in normobaric hyperoxia targeted therapy in acute subarachnoidal hemorrhage

Background: Low brain tissue oxygen tension (PbtO₂), or brain hypoxia, is an independent predictor of poor outcome. Increasing inspirational fraction of oxygen could have a significant influence on treating lower PbtO₂. Combined PbtO₂ therapy, compared to the approach that focus only on regulation of cerebral perfusion pressure and intracranial pressure, shows better patient outcomes. Monitoring of PbtO₂ could be helpful in individualizing treatment, preventing or limiting secondary brain injury, and maintaining better patient outcome.

Case description: We present a case of a patient with subarachnoidal hemorrhage to whom PbtO₂ monitor was implanted, and normobaric hyperoxia treatment was adjusted according to PbtO₂ measurement. The patient progressively recovered and was dismissed with Glasgow Coma Score 4/5/6.

Conclusion: The use of PbtO₂ monitoring may be useful for monitoring the local tissue values that are useful for induction of normobaric hyperoxia and optimizing the therapy toward more target-defined values. It is an important part of multimodal neuromonitoring, and is the gold standard for brain oxygenation monitoring that can lead to better patient outcome.