BACKGROUND: Brain hypoxia (BH) can aggravate outcome after severe traumatic brain injury (TBI). Whether BH or reduced brain oxygen (Pbto2) is an independent outcome predictor or a marker of disease severity is not fully elucidated.
OBJECTIVE: To analyze the relationship between Pbto2, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) and to examine whether BH correlates with worse outcome independently of ICP and CPP.
METHODS: We studied 103 patients monitored with ICP and Pbto2 for > 24 hours. Durations of BH (Pbto2 < 15 mm Hg), ICP > 20 mm Hg, and CPP < 60 mm Hg were calculated with linear interpolation, and their associations with outcome within 30 days were analyzed.
RESULTS: Duration of BH was longer in patients with unfavorable (Glasgow Outcome Scale score, 1-3) than in those with favorable (Glasgow Outcome Scale, 4-5) outcome (8.3 ± 15.9 vs 1.7 ± 3.7 hours; P < .01). In patients with intracranial hypertension, those with BH had fewer favorable outcomes (46%) than those without (81%; P < .01); similarly, patients with low CPP and BH were less likely to have favorable outcome than those with low CPP but normal Pbto2 (39% vs 83%; P < .01). After ICP, CPP, age, Glasgow Coma Scale score, Marshall computed tomography grade, and Acute Physiology and Chronic Health Evaluation II score were controlled for, BH was independently associated with poor prognosis (adjusted odds ratio for favorable outcome, 0.89 per hour of BH; 95% confidence interval, 0.79-0.99; P = .04).
CONCLUSION: Brain hypoxia is associated with poor short-term outcome after severe traumatic brain injury independently of elevated ICP, low CPP, and injury severity. Pbto2 may be an important therapeutic target after severe traumatic brain injury.
ABBREVIATIONS: AOR: adjusted odds ratio
APACHE II: Acute Physiology and Chronic Health Evaluation II
CI: confidence interval
CPP: cerebral perfusion pressure
GCS: Glasgow Coma Scale
ICP: intracranial pressure
IQR: interquartile range
MAP: mean arterial pressure
TBI: traumatic brain injury
Departments of *Neurosurgery
‖Anesthesiology and Critical Care, and
#Radiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
‡Department of Intensive Care Medicine and
¶Division of Pathophysiology, Lausanne University Medical Center, Lausanne, Switzerland
Correspondence: Peter D. LeRoux, MD, Department of Neurosurgery, Clinical Research Division, University of Pennsylvania Medical Center, 330 S 9th St, Philadelphia, PA 19107. E-mail: email@example.com
Received August 31, 2010
Accepted March 25, 2011