The first 72 hours of brain tissue oxygenation predicts patient survival with traumatic brain injury
The first 72 hours of brain tissue oxygenation predicts patient survival with traumatic brain injury
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DOI：
10.1097/ta.0b013e318249a0f4
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发表时间：
2012-05-01
影响因子：
3.4
通讯作者：
Ott, Mickey
中科院分区：
文献类型：
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作者：
Eriksson, Evert A.;Barletta, Jeffrey F.;Ott, Mickey
背景：脑组织氧合（pBtO（2））的利用是创伤性脑损伤治疗中一个重要但有争议的变量。我们假设pBtO（2）值在监测的第一个72小时是预测mortality.METHODS：回顾性地确定了连续的成人重度创伤性脑损伤患者和pBtO（2）监测者。收集pBtO（2）、脑灌注压（CPP）和颅内压（ICP）的时间指数测量值，并确定4小时阻滞的平均值。根据生存率对患者进行分层，采用重复测量方差分析比较pBtO（2）、CPP和ICP。结果：32例患者中有8，759个时间索引数据点。平均年龄为39 ± 16.5岁，损伤严重程度评分为27.7 ± 10.7，格拉斯哥昏迷量表评分为6.6 ± 3.4。存活率为68%。生存者的pBtO（2）值始终高于非生存者，包括年龄作为协变量（F +/- 12.898，p < 0.001）。在监测的8小时、12小时、20小时至44小时、52小时至60小时和72小时的时间点，个体pBtO（2）较高（p < 0.05）。存活者和非存活者之间的ICP（F = 1.690，p = 0.204）和CPP（F = 0.764，p = 0.389）值无差异，包括年龄作为协变量。分类和回归树分析确定29 mm Hg为pBtO（2）最能预测死亡率的阈值。结论：pBtO（2）神经监测的前72小时可预测死亡率。当pBtO（2）监测仪在监测的前72小时内保持低于29 mm Hg时，死亡率增加。这项研究挑战了传统使用的20 mm Hg的脑氧合阈值，并描绘了预测结果的监测pBtO（2）的时间。（J Trauma. 2012;72：1345-1349.版权所有（C）2012 Lippincott威廉姆斯& Wilkins）
BACKGROUND: Utilization of brain tissue oxygenation (pBtO(2)) is an important but controversial variable in the treatment of traumatic brain injury. We hypothesize that pBtO(2) values over the first 72 hours of monitoring are predictive of mortality.METHODS: Consecutive, adult patients with severe traumatic brain injury and pBtO(2) monitors were retrospectively identified. Time-indexed measurements of pBtO(2), cerebral perfusion pressure (CPP), and intracranial pressure (ICP) were collected, and average values over 4-hour blocks were determined. Patients were stratified according to survival, and repeated measures analysis of variance was used to compare pBtO(2), CPP, and ICP. The pBtO(2) threshold most predictive for survival was determined.RESULTS: There were 8,759 time-indexed data points in 32 patients. The mean age was 39 years +/- 16.5 years, injury severity score was 27.7 +/- 10.7, and Glasgow Coma Scale score was 6.6 +/- 3.4. Survival was 68%. Survivors consistently demonstrated higher pBtO(2) values compared with nonsurvivors including age as a covariate (F +/- 12.898, p < 0.001). Individual pBtO(2) was higher at the time points 8 hours, 12 hours, 20 hours to 44 hours, 52 hours to 60 hours, and 72 hours of monitoring (p < 0.05). There was no difference in ICP (F = 1.690, p = 0.204) and CPP (F = 0.764, p = 0.389) values between survivors and nonsurvivors including age as a covariate. Classification and regression tree analysis identified 29 mm Hg as the threshold at which pBtO(2) was most predictive for mortality.CONCLUSION: The first 72 hours of pBtO(2) neurologic monitoring predicts mortality. When the pBtO(2) monitor remains below 29 mm Hg in the first 72 hours of monitoring, mortality is increased. This study challenges the brain oxygenation threshold of 20 mm Hg that has been used conventionally and delineates a time for monitoring pBtO(2) that is predictive of outcome. (J Trauma. 2012;72: 1345-1349. Copyright (C) 2012 by Lippincott Williams & Wilkins)