The impact of early flow and brain oxygen crisis on the outcome of patients with severe traumatic brain injury.

作者信息

Marini Corrado P, Stoller Christy, Shah Omar, Policastro Antoni, Lombardo Gary, Asensio Juan A, Hu Yin C, Stiefel Michael F

机构信息

Division of Trauma Surgery, Surgical Critical Care and Acute Care Surgery, Department of Surgery, New York Medical College, Westchester Medical Center University Hospital, 100 Woods Rd Taylor Pavilion E 138, Valhalla, NY 10595, USA.

出版信息

Am J Surg. 2014 Dec;208(6):1071-7; discussion 1076-7. doi: 10.1016/j.amjsurg.2014.08.003. Epub 2014 Sep 22.

DOI:10.1016/j.amjsurg.2014.08.003

PMID:25440490

Abstract

BACKGROUND

Multimodality monitoring and goal-directed therapy may not prevent blood flow and brain oxygen (Flow/BrOx) crisis. We sought to determine the impact of these events on outcome in patients with severe traumatic brain injury (sTBI).

METHODS

Twenty-four patients with sTBI were treated to maintain intracranial pressure (ICP) less than or equal to 20 mm Hg, cerebral perfusion pressure (CPP) greater than or equal to 60 mm Hg, brain oxygen greater than or equal to 20 mm Hg, and near infrared spectroscopy greater than or equal to 60%. Flow/BrOx crisis events were recorded. The 14-day predicted mortality was compared with actual mortality.

RESULTS

Nonsurvivors had a significantly higher number of crisis events nonresponsive to treatment (P < .05). Mortality was 87.5% in patients with greater than or equal to 20 events versus 6.3% in patients with less than 20 events. The predicted mortality was 58%, whereas actual mortality was 33.3% (8/24), yielding a 42% reduction in mortality.

CONCLUSIONS

A multimodality monitoring and goal-directed therapy may decrease mortality in sTBI. However, Flow/BrOx crisis events still occur and predict a poor outcome.

摘要