Brain tissue oxygen directed management and outcome in the patients with severe traumatic brain injury


MRLIAN Andrej GÁL Roman SMRČKA Martin

Rok publikování 2014
Druh Konferenční abstrakty
Fakulta / Pracoviště MU

Lékařská fakulta

Popis Secondary damage is leading but often preventable cause of death in severe TBI. ICP control and treatment of CPP have significantly reduced the mortality. The effect of a brain tissue oxygen directed critical care could improve the 6-month GOS in patients with TBI. METHODS: 50 patients underwent prospective evaluation. They were treated in accordance with a PbtO2 values, maintaining brain oxygen level > 20 mm Hg and control ICP < 20 mm Hg. Outcomes were compared with those in a historical patient cohort. RESULTS: 65% of patients had an initially low PbtO2 and comparatively high ICP. Treatment with the PbtO2 directed protocol resulted in a 44% improvement in mean PbtO2 (p < 0.001), control of ICP and the maintenance of CPP. Persistently low cerebral oxygenation was seen in 37% of patients. Thus elevated ICP and a persistent low PbtO2 represented increasing odds of death. Survivors and patients with good outcomes generally had significantly higher mean daily PbtO2 and CPP values compared to nonsurvivors. Compared to the ICP/CPP cohort, the mean Glasgow Outcome Scale score at 6 months in patients treated with PbtO2 directed therapy was higher (p < 0.01) as was the reduction in mortality rate (23.7 vs 42.50%) CONCLUSIONS: The prevention and aggressive treatment of cerebral hypooxygenation and control of ICP values with a PbtO2 directed protocol reduced the mortality rate after TBI. More importantly, it resulted in improved 6-month clinical outcomes over the standard therapy at the authors' institution.

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