Monitoring of tissue oxygen pressure (PtiO2) in cerebral hypoxia: diagnostic and therapeutic approach

One of the main causes of secondary cerebral injury is cerebral hypoxia, basically of ischemic origin. However, cerebral tissue oxygenation depends on multiple physiological variables and cerebral hypoxia may be caused by an alteration of any one of them. Although several methods of continuous cerebral oxygenation monitoring of neurocritical patients have been developed, direct and continuous measurement of the oxygen pressure in the cerebral tissue (PtiO2) has been a reality in the handling of the neurocritical patients over recent years. This technique is highlighted by its reliability and value of the information that it provides. This present article presents a review of the most outstanding aspects of the PtiO2 monitoring and proposes a protocol for the interpretation of this monitoring technique. This algorithm attempts to facilitate the identification of the different types of different cerebral hypoxia and of the correct therapeutic choice in the complex decision making process in neurocritical patients at risk of cerebral hypoxia.