Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
Department of Neurosurgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Neurocrit Care. 2022 Dec;37(3):779-789. doi: 10.1007/s12028-022-01613-0. Epub 2022 Sep 30.
Traumatic brain injury (TBI) is a major public health burden, causing death and disability worldwide. Intracranial hypertension and brain hypoxia are the main mechanisms of secondary brain injury. As such, management strategies guided by intracranial pressure (ICP) and brain oxygen (PbtO) monitoring could improve the prognosis of these patients. Our objective was to summarize the current evidence regarding the impact of PbtO-guided therapy on the outcome of patients with TBI. We performed a systematic search of PubMed, Scopus, and the Cochrane library databases, following the protocol registered in PROSPERO. Only studies comparing PbtO/ICP-guided therapy with ICP-guided therapy were selected. Primary outcome was neurological outcome at 3 and 6 months assessed by using the Glasgow Outcome Scale; secondary outcomes included hospital and long-term mortality, burden of intracranial hypertension, and brain tissue hypoxia. Out of 6254 retrieved studies, 15 studies (n = 37,245 patients, of who 2184 received PbtO-guided therapy) were included in the final analysis. When compared with ICP-guided therapy, the use of combined PbO/ICP-guided therapy was associated with a higher probability of favorable neurological outcome (odds ratio 2.21 [95% confidence interval 1.72-2.84]) and of hospital survival (odds ratio 1.15 [95% confidence interval 1.04-1.28]). The heterogeneity (I) of the studies in each analysis was below 40%. However, the quality of evidence was overall low to moderate. In this meta-analysis, PbtO-guided therapy was associated with reduced mortality and more favorable neurological outcome in patients with TBI. The low-quality evidence underlines the need for the results from ongoing phase III randomized trials.
创伤性脑损伤（TBI）是全球范围内导致死亡和残疾的主要公共卫生负担。颅内压升高和脑缺氧是继发性脑损伤的主要机制。因此，基于颅内压（ICP）和脑氧（PbtO）监测的管理策略可以改善这些患者的预后。我们的目的是总结目前关于 PbtO 指导治疗对 TBI 患者结局影响的证据。我们按照 PROSPERO 中注册的方案，对 PubMed、Scopus 和 Cochrane 图书馆数据库进行了系统检索。仅选择了比较 PbtO/ICP 指导治疗与 ICP 指导治疗的研究。主要结局是使用格拉斯哥结局量表评估的 3 个月和 6 个月时的神经功能结局；次要结局包括医院和长期死亡率、颅内压升高负担和脑组织缺氧。在检索到的 6254 项研究中，有 15 项研究（n=37245 例患者，其中 2184 例接受 PbtO 指导治疗）纳入最终分析。与 ICP 指导治疗相比，联合使用 PbtO/ICP 指导治疗与良好的神经功能结局（比值比 2.21 [95%置信区间 1.72-2.84]）和医院存活率（比值比 1.15 [95%置信区间 1.04-1.28]）的可能性更高。每次分析的研究异质性（I）均低于 40%。然而，证据质量总体为低到中等。在这项荟萃分析中，PbtO 指导治疗与 TBI 患者的死亡率降低和更有利的神经功能结局相关。低质量证据强调了需要来自正在进行的 III 期随机试验的结果。
