Outcomes associated with brain tissue oxygen monitoring in patients with severe traumatic brain injury undergoing intracranial pressure monitoring

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  • 1 Departments of Neurosurgery,
  • | 2 Surgery, and
  • | 3 Neurology, State University of New York Upstate Medical University, Syracuse, New York
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OBJECTIVE

Brain tissue oxygen monitoring combined with intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (sTBI) may confer better outcomes than ICP monitoring alone. The authors sought to investigate this using a national database.

METHODS

The National Trauma Data Bank from 2013 to 2017 was queried to identify patients with sTBI who had an external ventricular drain or intraparenchymal ICP monitor placed. Patients were stratified according to the placement of an intraparenchymal brain tissue oxygen tension (PbtO2) monitor, and a 2:1 propensity score matching pair was used to compare outcomes in patients with and those without PbtO2 monitoring. Sensitivity analyses were performed using the entire cohort, and each model was adjusted for age, sex, Glasgow Coma Scale score, Injury Severity Score, presence of hypotension, insurance, race, and hospital teaching status. The primary outcome of interest was in-hospital mortality, and secondary outcomes included ICU length of stay (LOS) and overall LOS.

RESULTS

A total of 3421 patients with sTBI who underwent ICP monitoring were identified. Of these, 155 (4.5%) patients had a PbtO2 monitor placed. Among the propensity score–matched patients, mortality occurred in 35.4% of patients without oxygen monitoring and 23.4% of patients with oxygen monitoring (OR 0.53, 95% CI 0.33–0.85; p = 0.007). The unfavorable discharge rates were 56.3% and 47.4%, respectively, in patients with and those without oxygen monitoring (OR 1.41, 95% CI 0.87–2.30; p = 0.168). There was no difference in overall LOS, but patients with PbtO2 monitoring had a significantly longer ICU LOS and duration of mechanical ventilation. In the sensitivity analysis, PbtO2 monitoring was associated with decreased odds of mortality (OR 0.56, 95% CI 0.37–0.84) but higher odds of unfavorable discharge (OR 1.59, 95% CI 1.06–2.40).

CONCLUSIONS

When combined with ICP monitoring, PbtO2 monitoring was associated with lower inpatient mortality for patients with sTBI. This supports the findings of the recent Brain Oxygen Optimization in Severe Traumatic Brain Injury phase 2 (BOOST 2) trial and highlights the importance of the ongoing BOOST3 trial.

ABBREVIATIONS

ACS = American College of Surgeons; AIS = Abbreviated Injury Scale; BOOST = Brain Oxygen Optimization in Severe Traumatic Brain Injury; EVD = external ventricular drain; FiO2 = fraction of inspired oxygen; GCS = Glasgow Coma Scale; GOS-E = Glasgow Outcome Scale–Extended; ICP = intracranial pressure; ISS = Injury Severity Score; LOS = length of stay; NTDB = National Trauma Data Bank; PbtO2 = brain tissue oxygen tension; PSM = propensity score matching; sTBI = severe TBI; TBI = traumatic brain injury.

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Contributor Notes

Correspondence Haydn Hoffman: State University of New York Upstate Medical University, Syracuse, NY. hoffmanh@upstate.edu.

INCLUDE WHEN CITING Published online May 14, 2021; DOI: 10.3171/2020.11.JNS203739.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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