Brain tissue oxygen plus intracranial pressure monitoring versus isolated intracranial pressure monitoring in patients with traumatic brain injury: an updated meta-analysis of randomized controlled trials

• Published in: Acta neurochirurgica Vol. 166; no. 1; p. 240
• Main Authors: Pustilnik, Hugo Nunes, Medrado-Nunes, Gabriel Souza, Cerqueira, Gabriel Araújo, Meira, Davi Amorim, da Cunha, Beatriz Lopes Bernardo, Porto Junior, Silvio, Fontes, Jefferson Heber Marques, da Silva da Paz, Matheus Gomes, Alcântara, Tancredo, de Avellar, Leonardo Miranda
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 30-05-2024; Springer Nature B.V
• Subjects: Brain - physiopathology; Brain Injuries, Traumatic - mortality; Brain Injuries, Traumatic - physiopathology; Brain Injuries, Traumatic - therapy; Brain trauma; Cardiovascular diseases; Clinical trials; Humans; Hypoxia; Interventional Radiology; Intracranial Hypertension - diagnosis; Intracranial Hypertension - etiology; Intracranial pressure; Intracranial Pressure - physiology; Lungs; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Monitoring, Physiologic - methods; Mortality; Neurology; Neurophysiological Monitoring - methods; Neuroprotection; Neuroradiology; Neurosurgery; Oxygen - analysis; Oxygen - metabolism; Randomized Controlled Trials as Topic; Recovery of function; Review Article; Sepsis; Surgical Orthopedics; Traumatic brain injury; Multimodal monitoring; Traumatic brain injury; Intracranial pressure monitoring; Brain tissue oxygen monitoring; Neurointensive care
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-024-06125-8

Background
Intracranial pressure (ICP) monitoring plays a key role in patients with traumatic brain injury (TBI), however, cerebral hypoxia can occur without intracranial hypertension. Aiming to improve neuroprotection in these patients, a possible alternative is the association of Brain Tissue Oxygen Pressure (PbtO2) monitoring, used to detect PbtO2 tension.
Method
We systematically searched PubMed, Embase and Cochrane Central for RCTs comparing combined PbtO2 + ICP monitoring with ICP monitoring alone in patients with severe or moderate TBI. The outcomes analyzed were mortality at 6 months, favorable outcome (GOS ≥ 4 or GOSE ≥ 5) at 6 months, pulmonary events, cardiovascular events and sepsis rate.
Results
We included 4 RCTs in the analysis, totaling 505 patients. Combined PbtO2 + ICP monitoring was used in 241 (47.72%) patients. There was no significant difference between the groups in relation to favorable outcome at 6 months (RR 1.17; 95% CI 0.95–1.43;
p
 = 0.134; I
2
 = 0%), mortality at 6 months (RR 0.82; 95% CI 0.57–1.18;
p
 = 0.281; I
2
 = 34%), cardiovascular events (RR 1.75; 95% CI 0.86–3.52;
p
 = 0.120; I
2
 = 0%) or sepsis (RR 0.75; 95% CI 0.25–2.22;
p
 = 0.604; I
2
 = 0%). The risk of pulmonary events was significantly higher in the group with combined PbtO2 + ICP monitoring (RR 1.44; 95% CI 1.11–1.87;
p
 = 0.006; I
2
 = 0%).
Conclusions
Our findings suggest that combined PbtO2 + ICP monitoring does not change outcomes such as mortality, functional recovery, cardiovascular events or sepsis. Furthermore, we found a higher risk of pulmonary events in patients undergoing combined monitoring.