Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH.
Department of Neurosurgery, University of Cincinnati, Cincinnati, OH.
Crit Care Explor. 2024 Aug 9;6(8):e1139. doi: 10.1097/CCE.0000000000001139. eCollection 2024 Aug 1.
Evaluate the consistency and clinical impact of standardized multimodality neuromonitoring (MNM) interpretation and reporting within a system of care for patients with severe traumatic brain injury (sTBI).
Retrospective, observational historical case-control study.
Single-center academic level I trauma center.
Standardized interpretation of MNM data summarized within daily reports.
Consecutive patients with sTBI undergoing MNM were included. Historical controls were patients monitored before implementation of standardized MNM interpretation; cases were defined as patients with available MNM interpretative reports. Patient characteristics, physiologic data, and clinical outcomes were recorded, and clinical MNM reporting elements were abstracted. The primary outcome was the Glasgow Outcome Scale score 3-6 months postinjury. One hundred twenty-nine patients were included (age 42 ± 18 yr, 82% men); 45 (35%) patients were monitored before standardized MNM interpretation and reporting, and 84 (65%) patients were monitored after that. Patients undergoing standardized interpretative reporting received fewer hyperosmotic agents (3 [1-6] vs. 6 [1-8]; p = 0.04) and spent less time above an intracranial threshold of 22 mm Hg (22% ± 26% vs. 28% ± 24%; p = 0.05). The MNM interpretation cohort had a lower proportion of anesthetic days (48% [24-70%] vs. 67% [33-91%]; p = 0.02) and higher average end-tidal carbon dioxide during monitoring (34 ± 6 mm Hg vs. 32 ± 6 mm Hg; p < 0.01; d = 0.36). After controlling for injury severity, patients undergoing standardized MNM interpretation and reporting had an odds of 1.5 (95% CI, 1.37-1.59) for better outcomes.
Standardized interpretation and reporting of MNM data are a novel approach to provide clinical insight and to guide individualized critical care. In patients with sTBI, independent MNM interpretation and communication to bedside clinical care teams may result in improved intracranial pressure control, fewer medical interventions, and changes in ventilatory management. In this study, the implementation of a system for management, including standardized MNM interpretation, was associated with a significant improvement in outcome.
评估严重创伤性脑损伤（sTBI）患者治疗系统中标准化多模态神经监测（MNM）解读和报告的一致性和临床影响。
回顾性、观察性历史病例对照研究。
单中心一级创伤中心。
对每日报告中总结的 MNM 数据进行标准化解读。
纳入连续 sTBI 患者，行 MNM 监测。历史对照患者为实施 MNM 解读标准化前监测患者，病例定义为 MNM 解读报告可用患者。记录患者特征、生理数据和临床结局，并提取临床 MNM 报告要素。主要结局为损伤后 3-6 个月的格拉斯哥预后量表评分。共纳入 129 例患者（年龄 42 ± 18 岁，82%为男性）；45 例（35%）患者在实施 MNM 解读和报告标准化前接受监测，84 例（65%）患者在实施后接受监测。接受标准化解读报告的患者接受的高渗药物更少（3 [1-6] vs. 6 [1-8]；p = 0.04），颅内压阈值 22mmHg 以上时间更少（22% ± 26% vs. 28% ± 24%；p = 0.05）。MNM 解读组麻醉天数比例更低（48% [24-70%] vs. 67% [33-91%]；p = 0.02），监测期间呼气末二氧化碳平均值更高（34 ± 6mmHg vs. 32 ± 6mmHg；p < 0.01；d = 0.36）。在控制损伤严重程度后，接受标准化 MNM 解读和报告的患者，其预后更好的可能性为 1.5（95%CI，1.37-1.59）。
对 MNM 数据进行标准化解读和报告是一种提供临床见解和指导个体化重症监护的新方法。在 sTBI 患者中，独立的 MNM 解读并与床边临床护理团队沟通，可能改善颅内压控制、减少医疗干预，并改变通气管理。在本研究中，实施包括标准化 MNM 解读在内的管理系统与结局的显著改善相关。
