Normobaric hyperoxia—induced improvement in cerebral metabolism and reduction in intracranial pressure in patients with severe head injury: a prospective historical cohort—matched study

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Object. The effect of normobaric hyperoxia (fraction of inspired O2 [FIO2] concentration 100%) in the treatment of patients with traumatic brain injury (TBI) remains controversial. The aim of this study was to investigate the effects of normobaric hyperoxia on five cerebral metabolic indices, which have putative prognostic significance following TBI in humans.

Methods. At two independent neurointensive care units, the authors performed a prospective study of 52 patients with severe TBI who were treated for 24 hours with 100% FIO2, starting within 6 hours of admission. Data for these patients were compared with data for a cohort of 112 patients who were treated in the past; patients in the historical control group matched the patients in our study according to their Glasgow Coma Scale scores after resuscitation and their intracranial pressure within the first 8 hours after admission. Patients were monitored with the aid of intracerebral microdialysis and tissue O2 probes.

Normobaric hyperoxia treatment resulted in a significant improvement in biochemical markers in the brain compared with the baseline measures for patients treated in our study (patients acting as their own controls) and also compared with findings from the historical control group. In the dialysate the glucose levels increased (369.02 ± 20.1 µmol/L in the control group and 466.9 ± 20.39 µmol/L in the 100% O2 group, p = 0.001), whereas the glutamate and lactate levels significantly decreased (p < 0.005). There were also reductions in the lactate/glucose and lactate/pyruvate ratios. Intracranial pressure in the treatment group was reduced significantly both during and after hyperoxia treatment compared with the control groups (15.03 ± 0.8 mm Hg in the control group and 12.13 ± 0.75 mm Hg in the 100% O2 group, p < 0.005) with no changes in cerebral perfusion pressure. Outcomes of the patients in the treatment group improved.

Conclusions. The results of the study support the hypothesis that normobaric hyperoxia in patients with severe TBI improves the indices of brain oxidative metabolism. Based on these data further mechanistic studies and a prospective randomized controlled trial are warranted.

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Figures

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    Graph depicting relative recovery rates at different microdialysis flow rates in vitro.

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    Graph showing the hourly mean brain tissue PO2 in the hyperoxia and control patient groups throughout the entire monitoring period. Periods A through C were used for a comparison between groups. The probability value signifies statistical significance when the mean values of patient groups in Period B were compared.

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    Graphs demonstrating the hourly mean dialysate concentrations of glutamate (A) and lactate (B) in the hyperoxia and control patient groups throughout the entire monitoring period. Hyperoxia treatment was given during Period B. The probability value signifies statistical significance when the mean concentrations of analytes in the patient groups in Period B are compared.

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    Graphs demonstrating the hourly mean dialysate concentrations of glucose (A) and pyruvate (B) in the hyperoxia and control patient groups throughout the entire monitoring period.

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    A: Graphs showing the rate of decline in the glucose concentration of the dialysate in the hyperoxia and control groups before, during, and after treatment. B: Graphs demonstrating the rate of decline in the L/G ratio in the hyperoxia and control groups before and after treatment.

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    Graph demonstrating the hourly mean ICPs in the hyperoxia and control patient groups throughout the entire monitoring period. The probability values signify statistical significance when mean concentrations of ICP in the patient groups were compared in each period.

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