Document Detail


The first 72 hours of brain tissue oxygenation predicts patient survival with traumatic brain injury.
MedLine Citation:
PMID:  22673264     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Utilization of brain tissue oxygenation (pBtO(2)) is an important but controversial variable in the treatment of traumatic brain injury. We hypothesize that pBtO(2) values over the first 72 hours of monitoring are predictive of mortality.
METHODS: Consecutive, adult patients with severe traumatic brain injury and pBtO(2) monitors were retrospectively identified. Time-indexed measurements of pBtO(2), cerebral perfusion pressure (CPP), and intracranial pressure (ICP) were collected, and average values over 4-hour blocks were determined. Patients were stratified according to survival, and repeated measures analysis of variance was used to compare pBtO(2), CPP, and ICP. The pBtO(2) threshold most predictive for survival was determined.
RESULTS: There were 8,759 time-indexed data points in 32 patients. The mean age was 39 years ± 16.5 years, injury severity score was 27.7 ± 10.7, and Glasgow Coma Scale score was 6.6 ± 3.4. Survival was 68%. Survivors consistently demonstrated higher pBtO(2) values compared with nonsurvivors including age as a covariate (F = 12.898, p < 0.001). Individual pBtO(2) was higher at the time points 8 hours, 12 hours, 20 hours to 44 hours, 52 hours to 60 hours, and 72 hours of monitoring (p < 0.05). There was no difference in ICP (F = 1.690, p = 0.204) and CPP (F = 0.764, p = 0.389) values between survivors and nonsurvivors including age as a covariate. Classification and regression tree analysis identified 29 mm Hg as the threshold at which pBtO(2) was most predictive for mortality.
CONCLUSION: The first 72 hours of pBtO(2) neurologic monitoring predicts mortality. When the pBtO(2) monitor remains below 29 mm Hg in the first 72 hours of monitoring, mortality is increased. This study challenges the brain oxygenation threshold of 20 mm Hg that has been used conventionally and delineates a time for monitoring pBtO(2) that is predictive of outcome.
LEVEL OF EVIDENCE: III, prognostic study.
Authors:
Evert A Eriksson; Jeffrey F Barletta; Bryan E Figueroa; Bruce W Bonnell; Chris A Sloffer; Wayne E Vanderkolk; Karen J McAllen; Mickey Ott
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  72     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-06-07     Completed Date:  2012-08-21     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1345-9     Citation Subset:  AIM; IM    
Affiliation:
Division of General/Trauma Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA. evsurgery@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Brain Injuries / diagnosis,  metabolism,  mortality*
Cerebrovascular Circulation
Follow-Up Studies
Humans
Male
Monitoring, Physiologic / utilization*
Oxygen / metabolism*
Oxygen Consumption / physiology*
Predictive Value of Tests
Prognosis
Retrospective Studies
Survival Rate / trends
Time Factors
Trauma Severity Indices
United States / epidemiology
Chemical
Reg. No./Substance:
7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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