Goal Directed Brain Tissue Oxygen Monitoring Versus Conventional Management in Traumatic Brain Injury: An Analysis of In Hospital Recovery

• Published in: Neurocritical care Vol. 18; no. 1; pp. 20 - 25
• Main Authors: Green, Joel A., Pellegrini, Daniela C., Vanderkolk, Wayne E., Figueroa, Bryan E., Eriksson, Evert A.
• Format: Journal Article
• Language: English
• Published: New York Humana Press Inc 01-02-2013; Springer Nature B.V
• Subjects: Adult; Brain - blood supply; Brain - metabolism; Brain Injuries - diagnosis; Coma; Critical Care Medicine; Edema; Female; Heart rate; Hematoma; Hemodynamics; Hemoglobin; Hemorrhage; Hospitals; Humans; Intensive; Internal Medicine; Intracranial Pressure; Male; Medicine; Medicine & Public Health; Middle Aged; Monitoring, Physiologic - methods; Mortality; Neurology; Original Research; Oximetry - methods; Oxygen - analysis; Oxygen - metabolism; Patients; Retrospective Studies; Trauma; Trauma Centers; Traumatic brain injury; Treatment Outcome; Variables; Young Adult; United States > US; Traumatic brain injury; Outcome; Brain tissue oxygenation; Intracranial pressure; Intracranial monitor; Trauma; pBtO2
• DOI: 10.1007/s12028-012-9797-7
• EISSN: 1556-0961
• ISSN: 1541-6933

Background
Brain tissue oxygen monitoring (pBtO2) has been advocated in the treatment of patients with severe traumatic brain injuries (TBI); however, controversy exists regarding the improvements that pBtO2 monitoring provides. The objective of our study was to evaluate our experience and effect on mortality with goal directed pBtO2 monitoring for severe TBI compared to traditional ICP/CPP monitoring.
Methods
All patients admitted with severe TBI (GCS < 8) to our Level 1 trauma center from June 2007 through June 2009 were retrospectively analyzed. All patients had ICP monitoring and pBtO2 monitors were placed based on the current practices of the attending neurosurgeon producing two temporally matched cohorts of patients with and without pBtO2 monitors. Exclusion criteria were age <18 years and survival <24 h. Goal-directed therapy was utilized in all patients to maintain ICP <20 mmHg and CPP >60 mmHg. Patients with pBtO2 monitors were managed to maintain a level >20 mmHg.
Results
74 patients were treated for severe TBI over the 2-year study period with 37 patients in each group. Both groups were similar in age, sex, and admission Glascow Coma Score(GCS).The pBtO2-monitored group did, however, have significantly lower injury severity score [26 (25–30) vs. 30 (26–36),
p
 = 0.03] and AIS Chest [0 (0–0) vs. 2 (0–3),
p
 = 0.02]. There was no survival difference found (64.9 vs. 54.1 %,
p
 = 0.34). No difference with respect to discharge GCS or discharge Functional Independence Measure score was identified.
Conclusions
Compared with ICP/CPP-directed therapy alone, the addition of pBtO2 monitoring did not provide a survival or functional status improvement at discharge. The true clinical benefit of pBtO2 monitoring will require further study.