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Brain Tissue Oxygen-Based Therapy and Outcome After Severe Traumatic Brain Injury: A Systematic Literature Review

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Abstract

Observational clinical studies demonstrate that brain hypoxia is associated with poor outcome after severe traumatic brain injury (TBI). In this study, available medical literature was reviewed to examine whether brain tissue oxygen (PbtO2)-based therapy is associated with improved patient outcome after severe TBI. Clinical studies published between 1993 and 2010 that compared PbtO2-based therapy combined with intracranial and cerebral perfusion pressure (ICP/CPP)-based therapy to ICP/CPP-based therapy alone were identified from electronic databases, Index Medicus, bibliographies of pertinent articles, and expert consultation. For analysis, each selected paper had to have adequate data to determine odds ratios (ORs) and confidence intervals (CIs) of outcome described by the Glasgow outcome score (GOS). Seven studies that compared ICP/CPP and PbtO2- to ICP/CPP-based therapy were identified. There were no randomized studies and no comparison studies in children. Four studies, published in 2003, 2009, and 2010 that included 491 evaluable patients were used in the final analysis. Among patients who received PbtO2-based therapy, 121(38.8%) had unfavorable and 191 (61.2%) had a favorable outcome. Among the patients who received ICP/CPP-based therapy 104 (58.1%) had unfavorable and 75 (41.9%) had a favorable outcome. Overall PbtO2-based therapy was associated with favorable outcome (OR 2.1; 95% CI 1.4–3.1). Summary results suggest that combined ICP/CPP- and PbtO2-based therapy is associated with better outcome after severe TBI than ICP/CPP-based therapy alone. Cross-organizational practice variances cannot be controlled for in this type of review and so we cannot answer whether PbtO2-based therapy improves outcome. However, the potentially large incremental value of PbtO2-based therapy provides justification for a randomized clinical trial.

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Acknowledgments

EM-W and PDL are members of Integra Lifesciences Speaker’s Bureau. Supported in part by Research Grants from the Integra Foundation (PDL), Integra Neurosciences (PDL), and the Mary Elisabeth Groff Surgical and Medical Research Trust (PDL).

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Authors and Affiliations

  1. Departments of Neurosurgery, Clinical Research Division, University of Pennsylvania, 235 S 8th Street, Philadelphia, PA, 19106, USA

    Raj Nangunoori, Eileen Maloney-Wilensky, Michael Stiefel, Soojin Park, W. Andrew Kofke, Joshua M. Levine & Peter D. Le Roux

  2. Departments of Neurology, University of Pennsylvania, Philadelphia, PA, USA

    Soojin Park & Joshua M. Levine

  3. Departments of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA

    Soojin Park, W. Andrew Kofke & Joshua M. Levine

  4. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA

    Wei Yang

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  1. Raj Nangunoori
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  2. Eileen Maloney-Wilensky
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  3. Michael Stiefel
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  4. Soojin Park
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  6. Joshua M. Levine
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  7. Wei Yang
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  8. Peter D. Le Roux
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Correspondence to Peter D. Le Roux.

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Nangunoori, R., Maloney-Wilensky, E., Stiefel, M. et al. Brain Tissue Oxygen-Based Therapy and Outcome After Severe Traumatic Brain Injury: A Systematic Literature Review. Neurocrit Care 17, 131–138 (2012). https://doi.org/10.1007/s12028-011-9621-9

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