title: Mortality and Outcome Comparison Between Brain Tissue Oxygen Combined with Intracranial Pressure/Cerebral Perfusion Pressure-Guided Therapy and Intracranial Pressure/Cerebral Perfusion Pressure-Guided Therapy in Traumatic Brain Injury: A Meta-Analysis.
abstract: BACKGROUND
  The combination of brain tissue oxygen and standard intracranial pressure (ICP)/cerebral perfusion pressure (CPP)-guided therapy is thought to improve traumatic brain injury (TBI) prognosis compared with standard ICP/CPP-guided therapy. However, related results of previous observational studies and recently published cohort studies and randomized controlled trials (RCTs) remain controversial. The objective of this study was to compare the effect of the combined therapy with that of standard ICP/CPP-guided therapy on mortality rate, favorable outcome, ICP/CPP, and length of stay (LOS).
  
  
  METHODS
  We systematically searched PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and Web of Science in July 2016 for studies comparing the combined therapy and standard ICP/CPP-guided therapy. Random-effect and fixed-effect models were used for pooled analyses.
  
  
  RESULTS
  After screening 362 studies, 8 cohort studies and 1 RCT were included. Primary outcomes were mortality and favorable outcome. The overall mortality risk ratio showed no obvious advantages between the 2 groups (risk ratio [RR], 0.76; 95% confidence interval [CI], 0.54-1.06) and discharge mortality (RR, 1.01; 95% CI, 0.80-1.26) and 3-month mortality (RR, 0.77; 95% CI, 0.53-1.12). Compared with the ICP/CPP group, the combined group was more likely to achieve better outcome during the 6 months after TBI (RR, 1.26; 95% CI, 1.04-1.52) or exactly at 6 months (RR, 1.34; 95% CI, 1.07-1.68), whereas ICP (standardized mean difference [SMD], -0.19; 95% CI, -0.43 to 0.05), CPP (SMD, 0.13; 95% CI, -0.09 to 0.35), and LOS (SMD, 0.13; 95% CI, -0.11 to 0.37) showed no obvious differences.
  
  
  CONCLUSIONS
  Compared with standard ICP/CPP-guided therapy, brain tissue oxygen combined with ICP/CPP-guided therapy improved long-term outcomes without any effects on mortality, ICP/CPP, or LOS.
authors.affiliation: Department of Neurosurgery, Jinshan Hospital, Fudan University, Shanghai, P.R. China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Xie
authors.affiliation: Department of Neurosurgery, Jinshan Hospital, Fudan University, Shanghai, P.R. China.
authors.forename: Hai-Bing
authors.initials: HB
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery, Jinshan Hospital, Fudan University, Shanghai, P.R. China.
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Yan
authors.affiliation: Department of Neurosurgery, Jinshan Hospital, Fudan University, Shanghai, P.R. China.
authors.forename: Meng
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Jinshan Hospital, Fudan University, Shanghai, P.R. China. Electronic address: wersong@aliyun.com.
authors.forename: Er-Song
authors.initials: ES
authors.lastname: Wang
mesh_terms: D001921:Brain / Q000503:physiopathology; D000070642:Brain Injuries, Traumatic / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D006801:Humans; D007427:Intracranial Pressure; D064926:Neurophysiological Monitoring; D010100:Oxygen / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: Brain tissue oxygen monitoring; Cerebral perfusion pressure; Hypoxia, brain; Intracranial pressure; Meta-analysis; Traumatic brain injury