Outcome of severe traumatic brain injury: comparison of three monitoring approaches.
The determination of cerebral perfusion pressure (CPP) is regarded as vital in monitoring patients with severe traumatic brain injury. Besides indicating the status of cerebral blood flow (CBF), it also reveals the status of intracranial pressure (ICP). The abnormal or suboptimal level of CPP is commonly correlated with high values of ICP and therefore with poor patient outcomes. Eighty-two patients were divided into three groups of patients receiving treatment based on CPP and CBF, ICP alone, and conservative methods during two different observation periods. The characteristics of these three groups were compared based on age, sex, time between injury and hospital arrival, Glasgow Coma Scale score, pupillary reaction to light, surgical intervention, and computerized tomography scanning findings according to the Marshall classification system. Only time between injury and arrival (p = 0.001) was statistically significant. There was a statistically significant difference in the proportions of good outcomes between the multimodality group compared with the group of patients that underwent a single intracranial-based monitoring method and the group that received no monitoring (p = 0.003) based on a disability rating scale after a follow up of 12 months. Death was the focus of outcome in this study in which the multimodality approach to monitoring had superior results.
Department of Anesthesiology and Critical Care Medicine, and Neurosciences and Biostatistic Unit, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
Ruwaida
R
Isa
Wan Aasim
WA
Wan Adnan
Ghazaime
G
Ghazali
Zamzuri
Z
Idris
Abdul Rahman Izaini
AR
Ghani
Sani
S
Sayuthi
Mohamed Saufi
MS
Awang
Mazira Mohamad
MM
Ghazali
Nyi Nyi
NN
Naing
Jafri Malin
JM
Abdullah
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001925:Brain Damage, Chronic / Q000209:etiology*; D001930:Brain Injuries / Q000150:complications / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D002560:Cerebrovascular Circulation; D002648:Child; D015331:Cohort Studies; D003399:Craniotomy; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D007022:Hypotension / Q000150:complications; D007427:Intracranial Pressure; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010092:Oximetry; D012025:Reflex, Pupillary; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014159:Transducers; D016896:Treatment Outcome