Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury. Part 1: Relationship with outcome.
BACKGROUND
Intracranial pressure (ICP) monitoring and cerebral perfusion pressure (CPP) management are the current standards to guide care of severe traumatic brain injury (TBI). However, brain hypoxia and secondary brain injury can occur despite optimal ICP and CPP. In this study, we used brain tissue oxygen tension (PbtO(2)) monitoring to examine the association between multiple patient factors, including PbtO(2), and outcome in pediatric severe TBI.


METHODS
In this prospective observational study, 52 children (less than 15 years) with severe TBI were managed with continuous PbtO(2) and ICP monitoring. The relationships between outcome [Glasgow Outcome Score (GOS) and Pediatric Cerebral Performance Category Scale] and clinical, radiologic, treatment, and physiological variables, including PbtO(2), were examined using multiple logistic regression analysis.


RESULTS
Outcome was favorable in 40 patients (77%) and unfavorable (mortality, 9.6%; n = 5) in 12 (23%). In univariate analysis, the following variables had a significant association with unfavorable outcome: initial GCS, computed tomography classification, ICP(peak), mICP(24), mICP, CPP(low), CPP(<40), pupil reactivity, PbtO(2)(low), PbtO(2) < 5 mmHg, PbtO(2) < 10 mmHg, mPbtO(2)(24), and time-severity product. PbtO(2) parameters had the strongest independent association with poor outcome in multiple regression analysis. In particular, when PbtO(2) was <5 mmHg for >1 h, the adjusted OR for poor outcome was 27.4 (95% confidence interval, 1.9-391). No variables apart from PbtO(2) were independently associated with mortality when controlled for PbtO(2).


CONCLUSIONS
Reduced PbtO(2) is shown to be an independent factor associated with poor outcome in pediatric severe TBI in the largest study to date. It appears to have a stronger association with outcome than conventionally evaluated measures.
Figaji
Anthony A
AA
Divisions of Neurosurgery, School of Child and Adolescent Health, University of Cape Town, Red Cross Children's Hospital, Cape Town, South Africa. Anthony.Figaji@uct.ac.za
Zwane
Eugene
E
Thompson
Crispin
C
Fieggen
A Graham
AG
Argent
Andrew C
AC
Le Roux
Peter D
PD
Peter
Jonathan C
JC
D000293:Adolescent; D000704:Analysis of Variance; D001921:Brain / Q000378:metabolism*; D001930:Brain Injuries / Q000378:metabolism* / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D010100:Oxygen / Q000378:metabolism*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D010100:Oxygen