This study was designed to evaluate the clinical practicability of a multimodality monitoring in neurosurgical comatose patients. In seven patients cerebral lactate, pyruvate, glucose and glycerol concentrations were measured via a microdialysis probe. Furthermore, the partial pressures of oxygen and carbon dioxide as well as pH and brain temperature were monitored via a paratrend multiparameter probe in six patients. The catheters were inserted after neurosurgical evacuation of a mass lesion or via a burr hole in the fronto-parietal region. The measured values were then analysed upon statistical relationships regarding clinical and paraclinical findings. Especially the gas partial pressures, but also other parameters revealed a strong variability. Statistical relationships between clinical and paraclinical findings could be shown. The monitoring's placement in relation to the primary lesion showed a highly significant influence on the absolute values measured. Furthermore there were grave intra- and interindividual differences, especially when measured near the primary lesion. The assessment of the lower threshold of cerebral autoregulation proved to be clinically sensitive and valid. Below the lower threshold a significant drop in oxygen partial pressure could be detected. Under clinical practicable terms the monitoring showed to be easy to handle an there were no complications and few artifacts. The cerebral oxygen partial pressure measurement improves CPP-oriented intensive therapy. |