Management guided by brain tissue oxygen monitoring and outcome following severe traumatic brain injury.
OBJECTIVE
The authors sought to describe changes in clinical management associated with brain tissue oxygen (PbO(2)) monitoring and how these changes affected outcomes and resource utilization.


METHODS
The cohort study comprised 629 patients admitted to a Level I trauma center with a diagnosis of severe traumatic brain injury over a period of 3 years. Hospital mortality rate, neurological outcome, and resource utilization of 123 patients who underwent both PbO(2) and intracranial pressure (ICP) monitoring were compared with the same measures in 506 patients who underwent ICP monitoring only. The main outcomes were hospital mortality rate, functional independence at hospital discharge, duration of mechanical ventilation, hospital length of stay, and hospital cost. Multivariable regression with robust variance was used to estimate the adjusted differences in the main outcome measures between patient groups. The models were adjusted for patient age, severity of injury, and pathological features seen on head CT scan at admission.


RESULTS
On average, patients who underwent ICP/PbO(2) monitoring were younger and had more severe injuries than patients who received ICP monitoring alone. Relatively more patients treated with PbO(2) monitoring received osmotic therapy, vasopressors, and prolonged sedation. After adjustment for baseline characteristics, the hospital mortality rate was, if anything, slightly higher in patients undergoing PbO(2)-guided management than in patients monitored with ICP only (adjusted mortality difference 4.4%, 95% CI -3.9 to 13%). Patients who underwent PbO(2)-guided management also had lower adjusted functional independence scores at hospital discharge (adjusted score difference -0.75, 95% CI -1.41 to -0.09). There was a 27% relative increase (95% CI 6-53%) in the median hospital length of stay when the PbO(2) group was compared with the ICP-only group.


CONCLUSIONS
The mortality rate in patients with traumatic brain injury whose clinical management was guided by PbO(2) monitoring was not reduced in comparison with that in patients who received ICP monitoring alone. Brain tissue oxygen monitoring was associated with worse neurological outcome and increased hospital resource utilization.
Martini
Ross P
RP
The Warren Alpert Medical School, Brown University, Providence, Rhode Island 02912, USA. ross_martini@brown.edu
Deem
Steven
S
Yanez
N David
ND
Chesnut
Randall M
RM
Weiss
Noel S
NS
Daniel
Stephen
S
Souter
Michael
M
Treggiari
Miriam M
MM
D000328:Adult; D001921:Brain / Q000378:metabolism*; D001930:Brain Injuries / Q000175:diagnosis* / Q000378:metabolism* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000378:metabolism*; D011379:Prognosis; D012044:Regression Analysis; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D016896:Treatment Outcome
D010100:Oxygen