Limitations of threshold-based brain oxygen monitoring for seizure detection

Soojin Park; Alexander Roederer; Ram Mani; Sarah Schmitt; Peter D. LeRoux; Lyle H. Ungar; Insup Lee; Scott E. Kasner

doi:10.1007/s12028-011-9540-9

Limitations of threshold-based brain oxygen monitoring for seizure detection

Soojin Park, Alexander Roederer, Ram Mani, Sarah Schmitt, Peter D. LeRoux, Lyle H. Ungar, Insup Lee, Scott E. Kasner

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Background Brain tissue oxygen (PbtO ₂) monitors are utilized in a threshold-based fashion, triggering actions based on the presumption of tissue compromise when PbtO ₂ is less than 20 mmHg. Some early published practice guidelines suggest that seizure is a potential culprit when PbtO ₂ crosses this threshold; evidence for this is not well defined. Methods Data were collected manually as part of a prospective observational database. PbtO ₂ monitors and continuous electroencephalogram (cEEG) were placed by clinical protocol in aneurysmal subarachnoid hemorrhage (aSAH) or traumatic brain injury (TBI) patients with a Glasgow Coma Scale (GCS) ≤ 8. Eight patients with discrete seizures during an overlapping monitored period were identified. Probability of seizure when PbtO ₂ value was <20 mmHg (and the inverse) were calculated. Results There were 343 distinct seizure episodes and 1797 PbtO ₂ measurements. 8.9% of seizures were followed by a PbtO ₂ value below 20 mmHg. Of all observed low PbtO ₂ values, 3.8% were associated with seizure. Seizure length did not influence PbtO ₂. Two patients with the highest number of seizures developed low PbtO ₂ values post-seizure. Conclusions Seizures were neither associated with a PbtO ₂ value of <20 mmHg nor associated with a drop in PbtO ₂ value across a clinically significant threshold. However, we cannot rule out the existence of any relationship between PbtO ₂ and seizure with this limited data set. Prospective research using electronically recorded data is required to more effectively examine the relationship between PbtO ₂ and seizure.

Original language	English (US)
Pages (from-to)	469-476
Number of pages	8
Journal	Neurocritical Care
Volume	15
Issue number	3
DOIs	https://doi.org/10.1007/s12028-011-9540-9
State	Published - Dec 2011
Externally published	Yes

All Science Journal Classification (ASJC) codes

Clinical Neurology
Critical Care and Intensive Care Medicine

Keywords

Brain injuries/physiopathology
Non-convulsive seizure disorder
Oxygen/Metabolism
Physiologic monitoring
Subarachnoid hemorrhage
Traumatic brain injury

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10.1007/s12028-011-9540-9

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title = "Limitations of threshold-based brain oxygen monitoring for seizure detection",

abstract = "Background Brain tissue oxygen (PbtO 2) monitors are utilized in a threshold-based fashion, triggering actions based on the presumption of tissue compromise when PbtO 2 is less than 20 mmHg. Some early published practice guidelines suggest that seizure is a potential culprit when PbtO 2 crosses this threshold; evidence for this is not well defined. Methods Data were collected manually as part of a prospective observational database. PbtO 2 monitors and continuous electroencephalogram (cEEG) were placed by clinical protocol in aneurysmal subarachnoid hemorrhage (aSAH) or traumatic brain injury (TBI) patients with a Glasgow Coma Scale (GCS) ≤ 8. Eight patients with discrete seizures during an overlapping monitored period were identified. Probability of seizure when PbtO 2 value was <20 mmHg (and the inverse) were calculated. Results There were 343 distinct seizure episodes and 1797 PbtO 2 measurements. 8.9% of seizures were followed by a PbtO 2 value below 20 mmHg. Of all observed low PbtO 2 values, 3.8% were associated with seizure. Seizure length did not influence PbtO 2. Two patients with the highest number of seizures developed low PbtO 2 values post-seizure. Conclusions Seizures were neither associated with a PbtO 2 value of <20 mmHg nor associated with a drop in PbtO 2 value across a clinically significant threshold. However, we cannot rule out the existence of any relationship between PbtO 2 and seizure with this limited data set. Prospective research using electronically recorded data is required to more effectively examine the relationship between PbtO 2 and seizure.",

keywords = "Brain injuries/physiopathology, Non-convulsive seizure disorder, Oxygen/Metabolism, Physiologic monitoring, Subarachnoid hemorrhage, Traumatic brain injury",

author = "Soojin Park and Alexander Roederer and Ram Mani and Sarah Schmitt and LeRoux, {Peter D.} and Ungar, {Lyle H.} and Insup Lee and Kasner, {Scott E.}",

year = "2011",

month = dec,

doi = "10.1007/s12028-011-9540-9",

language = "English (US)",

volume = "15",

pages = "469--476",

journal = "Neurocritical Care",

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AU - Park, Soojin

AU - Roederer, Alexander

AU - Mani, Ram

AU - Schmitt, Sarah

AU - LeRoux, Peter D.

AU - Ungar, Lyle H.

AU - Lee, Insup

AU - Kasner, Scott E.

PY - 2011/12

Y1 - 2011/12

N2 - Background Brain tissue oxygen (PbtO 2) monitors are utilized in a threshold-based fashion, triggering actions based on the presumption of tissue compromise when PbtO 2 is less than 20 mmHg. Some early published practice guidelines suggest that seizure is a potential culprit when PbtO 2 crosses this threshold; evidence for this is not well defined. Methods Data were collected manually as part of a prospective observational database. PbtO 2 monitors and continuous electroencephalogram (cEEG) were placed by clinical protocol in aneurysmal subarachnoid hemorrhage (aSAH) or traumatic brain injury (TBI) patients with a Glasgow Coma Scale (GCS) ≤ 8. Eight patients with discrete seizures during an overlapping monitored period were identified. Probability of seizure when PbtO 2 value was <20 mmHg (and the inverse) were calculated. Results There were 343 distinct seizure episodes and 1797 PbtO 2 measurements. 8.9% of seizures were followed by a PbtO 2 value below 20 mmHg. Of all observed low PbtO 2 values, 3.8% were associated with seizure. Seizure length did not influence PbtO 2. Two patients with the highest number of seizures developed low PbtO 2 values post-seizure. Conclusions Seizures were neither associated with a PbtO 2 value of <20 mmHg nor associated with a drop in PbtO 2 value across a clinically significant threshold. However, we cannot rule out the existence of any relationship between PbtO 2 and seizure with this limited data set. Prospective research using electronically recorded data is required to more effectively examine the relationship between PbtO 2 and seizure.

AB - Background Brain tissue oxygen (PbtO 2) monitors are utilized in a threshold-based fashion, triggering actions based on the presumption of tissue compromise when PbtO 2 is less than 20 mmHg. Some early published practice guidelines suggest that seizure is a potential culprit when PbtO 2 crosses this threshold; evidence for this is not well defined. Methods Data were collected manually as part of a prospective observational database. PbtO 2 monitors and continuous electroencephalogram (cEEG) were placed by clinical protocol in aneurysmal subarachnoid hemorrhage (aSAH) or traumatic brain injury (TBI) patients with a Glasgow Coma Scale (GCS) ≤ 8. Eight patients with discrete seizures during an overlapping monitored period were identified. Probability of seizure when PbtO 2 value was <20 mmHg (and the inverse) were calculated. Results There were 343 distinct seizure episodes and 1797 PbtO 2 measurements. 8.9% of seizures were followed by a PbtO 2 value below 20 mmHg. Of all observed low PbtO 2 values, 3.8% were associated with seizure. Seizure length did not influence PbtO 2. Two patients with the highest number of seizures developed low PbtO 2 values post-seizure. Conclusions Seizures were neither associated with a PbtO 2 value of <20 mmHg nor associated with a drop in PbtO 2 value across a clinically significant threshold. However, we cannot rule out the existence of any relationship between PbtO 2 and seizure with this limited data set. Prospective research using electronically recorded data is required to more effectively examine the relationship between PbtO 2 and seizure.

KW - Brain injuries/physiopathology

KW - Non-convulsive seizure disorder

KW - Oxygen/Metabolism

KW - Physiologic monitoring

KW - Subarachnoid hemorrhage

KW - Traumatic brain injury

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SN - 1541-6933

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EP - 476

JO - Neurocritical Care

JF - Neurocritical Care

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ER -

Limitations of threshold-based brain oxygen monitoring for seizure detection

Abstract

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