Brain Hypoxia Is Associated With Short-term Outcome After Severe Traumatic Brain Injury Independently of Intracranial Hypertension and Low Cerebral Perfusion Pressure

Abstract BACKGROUND Brain hypoxia (BH) can aggravate outcome after severe traumatic brain injury (TBI). Whether BH or reduced brain oxygen (Pbto2) is an independent outcome predictor or a marker of disease severity is not fully elucidated. OBJECTIVE To analyze the relationship between Pbto2, intracr...

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Published in:Neurosurgery Vol. 69; no. 5; pp. 1037 - 1045
Main Authors: Oddo, Mauro, Levine, Joshua M., Mackenzie, Larami, Frangos, Suzanne, Feihl, François, Kasner, Scott E., Katsnelson, Michael, Pukenas, Bryan, Macmurtrie, Eileen, Maloney-Wilensky, Eileen, Kofke, W. Andrew, LeRoux, Peter D.
Format: Journal Article
Language:English
Published: Hagerstown, MD Oxford University Press 01.11.2011
Lippincott Williams & Wilkins
Wolters Kluwer Health, Inc
Subjects:
Adult
Biological and medical sciences
Brain Injuries - complications
Brain Injuries - mortality
Cerebrovascular Circulation - physiology
Cerebrovascular Disorders - etiology
Cerebrovascular Disorders - mortality
Female
Humans
Hypertension
Hypotension - etiology
Hypotension - mortality
Hypoxia
Hypoxia, Brain - etiology
Hypoxia, Brain - mortality
Intracranial Pressure - physiology
Male
Medical sciences
Middle Aged
Neurosurgery
Prospective Studies
Retrospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Time Factors
Traumatic brain injury
Young Adult
Indepedent predictor
Intracranial Pressure
Traumatic brain injury
Outcome
Cerebral perfusion pressure
Brain tissue oxygen pressure
Brain hypoxia
Short term
Oxygen
Nervous system diseases
Prognosis
Intracranial hypertension
Intracranial pressure
Cerebral disorder
Encephalon
Surgery
Central nervous system disease
Low pressure
Hypoxia
Head trauma
Oxygen pressure
ISSN:0148-396X, 1524-4040, 1524-4040
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Summary:Abstract BACKGROUND Brain hypoxia (BH) can aggravate outcome after severe traumatic brain injury (TBI). Whether BH or reduced brain oxygen (Pbto2) is an independent outcome predictor or a marker of disease severity is not fully elucidated. OBJECTIVE To analyze the relationship between Pbto2, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) and to examine whether BH correlates with worse outcome independently of ICP and CPP. METHODS We studied 103 patients monitored with ICP and Pbto2 for > 24 hours. Durations of BH (Pbto2 < 15 mm Hg), ICP > 20 mm Hg, and CPP < 60 mm Hg were calculated with linear interpolation, and their associations with outcome within 30 days were analyzed. RESULTS Duration of BH was longer in patients with unfavorable (Glasgow Outcome Scale score, 1–3) than in those with favorable (Glasgow Outcome Scale, 4–5) outcome (8.3 ± 15.9 vs 1.7 ± 3.7 hours; P < .01). In patients with intracranial hypertension, those with BH had fewer favorable outcomes (46%) than those without (81%; P < .01); similarly, patients with low CPP and BH were less likely to have favorable outcome than those with low CPP but normal Pbto2 (39% vs 83%; P < .01). After ICP, CPP, age, Glasgow Coma Scale score, Marshall computed tomography grade, and Acute Physiology and Chronic Health Evaluation II score were controlled for, BH was independently associated with poor prognosis (adjusted odds ratio for favorable outcome, 0.89 per hour of BH; 95% confidence interval, 0.79-0.99; P = .04). CONCLUSION Brain hypoxia is associated with poor short-term outcome after severe traumatic brain injury independently of elevated ICP, low CPP, and injury severity. Pbto2 may be an important therapeutic target after severe traumatic brain injury.
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ISSN:0148-396X
1524-4040
1524-4040
DOI:10.1227/NEU.0b013e3182287ca7