title: The impact of early flow and brain oxygen crisis on the outcome of patients with severe traumatic brain injury.
abstract: BACKGROUND
  Multimodality monitoring and goal-directed therapy may not prevent blood flow and brain oxygen (Flow/BrOx) crisis. We sought to determine the impact of these events on outcome in patients with severe traumatic brain injury (sTBI).
  
  
  METHODS
  Twenty-four patients with sTBI were treated to maintain intracranial pressure (ICP) less than or equal to 20 mm Hg, cerebral perfusion pressure (CPP) greater than or equal to 60 mm Hg, brain oxygen greater than or equal to 20 mm Hg, and near infrared spectroscopy greater than or equal to 60%. Flow/BrOx crisis events were recorded. The 14-day predicted mortality was compared with actual mortality.
  
  
  RESULTS
  Nonsurvivors had a significantly higher number of crisis events nonresponsive to treatment (P < .05). Mortality was 87.5% in patients with greater than or equal to 20 events versus 6.3% in patients with less than 20 events. The predicted mortality was 58%, whereas actual mortality was 33.3% (8/24), yielding a 42% reduction in mortality.
  
  
  CONCLUSIONS
  A multimodality monitoring and goal-directed therapy may decrease mortality in sTBI. However, Flow/BrOx crisis events still occur and predict a poor outcome.
authors.affiliation: Division of Trauma Surgery, Surgical Critical Care and Acute Care Surgery, Department of Surgery, New York Medical College, Westchester Medical Center University Hospital, 100 Woods Rd Taylor Pavilion E 138, Valhalla, NY 10595, USA. Electronic address: marinic@wcmc.com.
authors.forename: Corrado P
authors.initials: CP
authors.lastname: Marini
authors.affiliation: Division of Trauma Surgery, Surgical Critical Care and Acute Care Surgery, Department of Surgery, New York Medical College, Westchester Medical Center University Hospital, 100 Woods Rd Taylor Pavilion E 138, Valhalla, NY 10595, USA.
authors.forename: Christy
authors.initials: C
authors.lastname: Stoller
authors.affiliation: Division of Neurology, Department of Medicine, New York Medical College, Westchester Medical Center University Hospital, 100 Woods Rd Taylor Pavilion E 138, Valhalla, NY 10595, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Shah
authors.affiliation: Division of Trauma Surgery, Surgical Critical Care and Acute Care Surgery, Department of Surgery, New York Medical College, Westchester Medical Center University Hospital, 100 Woods Rd Taylor Pavilion E 138, Valhalla, NY 10595, USA.
authors.forename: Antoni
authors.initials: A
authors.lastname: Policastro
authors.affiliation: Division of Trauma Surgery, Surgical Critical Care and Acute Care Surgery, Department of Surgery, New York Medical College, Westchester Medical Center University Hospital, 100 Woods Rd Taylor Pavilion E 138, Valhalla, NY 10595, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Lombardo
authors.affiliation: Division of Trauma Surgery, Surgical Critical Care and Acute Care Surgery, Department of Surgery, New York Medical College, Westchester Medical Center University Hospital, 100 Woods Rd Taylor Pavilion E 138, Valhalla, NY 10595, USA.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Asensio
authors.affiliation: Department of Neurosurgery, New York Medical College, Westchester Medical Center University Hospital, 100 Woods Rd Taylor Pavilion E 138, Valhalla, NY 10595, USA.
authors.forename: Yin C
authors.initials: YC
authors.lastname: Hu
authors.affiliation: Department of Neurosurgery, New York Medical College, Westchester Medical Center University Hospital, 100 Woods Rd Taylor Pavilion E 138, Valhalla, NY 10595, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Stiefel
mesh_terms: D000328:Adult; D001921:Brain / Q000378:metabolism*; D001930:Brain Injuries / Q000378:metabolism* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003422:Critical Care / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010100:Oxygen / Q000378:metabolism* / Q000627:therapeutic use*; D019265:Spectroscopy, Near-Infrared; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: Brain flow; CRASH model; Multimodality monitoring; Oxygen crisis; TBI