gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Continuous computer-based monitoring in patients with subarachnoid hemorrhage

Meeting Abstract

  • corresponding author Thomas Reithmeier - Universität zu Köln, Klinik für Allgemeine Neurochirurgie, Köln
  • P. Pakos - Universität zu Köln, Klinik für Allgemeine Neurochirurgie, Köln
  • M. Löhr - Universität zu Köln, Klinik für Allgemeine Neurochirurgie, Köln
  • R.-I. Ernestus - Universität zu Köln, Klinik für Allgemeine Neurochirurgie, Köln

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocJM III.04

The electronic version of this article is the complete one and can be found online at:

Published: April 23, 2004

© 2004 Reithmeier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




Effective treatment of vasospasm after subarachnoid hemorrhage (SAH) is an unsolved problem. Triple-H-therapy is the standard procedure to prevent ischemic deficits induced by vasospam after SAH from an intracranial aneurysm. Up to date two randomized prospective studies exist that did not prove the therapeutic or prognostic effect of Triple-H-therapy. Therefore, we digitally and simultaneously recorded brain tissue oxygenation (ptO2) and multiple hemodynamic parameters to identify critical hemodynamic thresholds for maintaining adequate oxygen supply to the brain.

Patients and methods

Twelve patients with SAH due to an intracranial aneurysm and an initial Hunt and Hess grade between 3 and 5 were included in this study. ptO2 was monitored with a LICOX oxygen sensor placed in the frontal cortex. Monitoring of multiple hemodynamic parameters, including continuous pulse contour cardiac output, systolic, diastolic, and mean arterial pressure as well as systemic vascular resistance was performed with the PiCCOplus technology. Data were downloaded simultaneously at a frequency of one data set per minute to two notebook unites and stored in a Microsoft Excel format for analysis. When ptO2 decreased below 10 mmHg or transcranial doppler sonography (TCD) demonstrated an elevation of blood flow velocities over 200 cm/sec., systolic blood pressure was raised to a minimum of 180 mmHg by fluid expansion and application of catecholamines.


A total of 83,729 data samples were stored for these 12 patients representing 58 days of monitoring. In 3 patients with severe cerebral vasospasm confirmed by TCD, a decrease in ptO2 below 10 mmHg was successfully reversed by raising systolic blood pressure over 180 mmHg and mean arterial blood pressure over 100 mmHg. In 6 patients, we observed a decrease of ptO2 below 10 mmHg without a correlation to blood flow velocities. In these patients, an increase of blood pressure resulted in an inconstant improvement of cerebral oxygenation. However, spontaneous raise of ptO2 over 10 mmHg was also observed.


In cases of severe vasospasm detected by TCD, efficiancy of hyperdynamic therapy is confirmed by the continuous determination of cerebral ptO2. However, there may be events of a clinically relevant decrease in brain tissue oxygenation which can only be detected by continuous monitoring of ptO2 and not by the measurement of cerebral blood flow velocities. Thus, other therapeutic strategies than Triple-H-therapy have to be developed to achieve an adequate oxygen supply of the brain after SAH.