Utilization of Brain Tissue Oxygenation Monitoring and Association with Mortality Following Severe Traumatic Brain Injury.
Utilization of Brain Tissue Oxygenation Monitoring and Association with Mortality Following Severe Traumatic Brain Injury.
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DOI：
10.1007/s12028-021-01394-y
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发表时间：
2022-04
影响因子：
3.5
通讯作者：
中科院分区：
文献类型：
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描述严重TBI后脑组织氧（PbtO 2）监测的利用模式，并确定与死亡率、医疗利用和肺毒性的相关性。我们对2008年至2016年期间参加美国外科医生学会国家创伤数据库的美国创伤中心患者进行了回顾性队列研究。我们检查了18岁以上的重度TBI患者（定义为入院格拉斯哥昏迷评分≤ 8），这些患者从入院起存活超过24小时，需要颅内压（ICP）监测。主要暴露是PbtO 2监测器放置。主要结局是住院死亡率，定义为住院期间或出院至临终关怀机构期间的死亡。检查次要结局以确定PbtO 2监测与医疗保健利用和肺毒性的相关性，包括：1）重症监护室（ICU）住院时间; 2）住院时间; 3）急性呼吸窘迫综合征（ARDS）的发生。使用回归分析评估暴露于PbtO 2监测器放置的患者与未暴露于PbtO 2监测器放置的患者之间的结局差异，并使用倾向加权来解决由于治疗组的非随机分配和受试者脱落导致的选择偏倚。35，501例患者接受了ICP监测仪的放置。1，346例（3.8%）患者还接受了PbtO 2监测仪放置，日历年和医院之间存在显著差异。置入PbtO 2监测仪的患者的粗住院死亡率为31.1%，而仅置入ICP监测仪的患者为33.5%[校正风险比（aRR）0.84，95% CI 0.76 - 0.93]。置入PbtO 2监测仪和仅置入ICP监测仪的患者的ARDS发生率相当（9.2% vs 9.8%，aRR 0.89，95% CI 0.73 - 1.09）。在整个研究期间，PbtO 2监测仪的使用情况因日历年和医院而异。与单独ICP监测相比，除ICP监测外，PbtO 2监测与住院死亡率降低、住院时间延长和ARDS风险相似相关。这些发现为临床医生护理严重TBI患者提供了进一步的指导，同时等待进一步的随机对照试验的完成。
Describe the utilization patterns of brain tissue oxygen (PbtO2) monitoring following severe TBI and determine associations with mortality, healthcare utilization, and pulmonary toxicity. We conducted a retrospective cohort study of patients from United States trauma centers participating in the American College of Surgeons National Trauma Databank between 2008 and 2016. We examined patients with severe TBI (defined by admission Glasgow Coma Scale ≤ 8) over the age of 18 years, who survived more than 24 hours from admission and required intracranial pressure (ICP) monitoring. The primary exposure was PbtO2 monitor placement. The primary outcome was hospital mortality, defined as death during the hospitalization or discharge to hospice. Secondary outcomes were examined to determine the association of PbtO2 monitoring with healthcare utilization and pulmonary toxicity and included: 1) Intensive care unit (ICU) length of stay; 2) Hospital length of stay; and 3) Development of the acute respiratory distress syndrome (ARDS). Regression analysis was used to assess differences in outcomes between patients exposed to PbtO2 monitor placement versus those without, with propensity-weighting to address selection bias due to both the non-random allocation of treatment groups and subject drop-out. 35,501 patients underwent placement of an ICP monitor. 1,346 (3.8%) patients also underwent PbtO2 monitor placement, with significant variation by calendar year and hospital. Patients who underwent placement of PbtO2 monitor had a crude in-hospital mortality of 31.1%, compared to 33.5% in patients who only underwent placement of an ICP monitor [Adjusted Risk Ratio (aRR) 0.84, 95% CI 0.76 – 0.93]. The development of the ARDS was comparable between patients who underwent placement of a PbtO2 monitor and only an ICP monitor (9.2% versus 9.8%, aRR 0.89, 95% CI 0.73 – 1.09). PbtO2 monitor utilization varied widely throughout the study period by calendar year and hospital. PbtO2 monitoring in addition to ICP monitoring, compared to ICP monitoring alone, was associated with decreased in hospital mortality, longer length of stay, and similar risk of ARDS. These findings provide further guidance for clinicians caring for patients with severe TBI, while awaiting completion of further randomized controlled trials.
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影响因子：
4.8
作者：
Carney, Nancy;Totten, Annette M.;Ghajar, Jamshid
通讯作者：
Ghajar, Jamshid
影响因子：
2.9
作者：
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影响因子：
3.7
作者：
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通讯作者：
McClain, Lydia I. Gilbert
影响因子：
3.1
作者：
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通讯作者：
Krishnamoorthy, Vijay
影响因子：
33.9
作者：
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通讯作者：
Xu, Likang