Elsevier

Surgery

Volume 146, Issue 4, October 2009, Pages 585-591
Surgery

Central Surgical Association
Neurologic outcomes with cerebral oxygen monitoring in traumatic brain injury

https://doi.org/10.1016/j.surg.2009.06.059Get rights and content

Background

Optimizing cerebral oxygenation is advocated to improve outcome in head-injured patients. The purpose of this study was to compare outcomes in brain-injured patients treated with 2 types of monitors.

Methods

Patients with traumatic brain injury and a Glasgow Coma Scale score<8 were identified on admission. A polarographic cerebral oxygen/pressure monitor (Licox) or fiberoptic intracranial pressure monitor (Camino) was inserted. An evidence-based algorithm for treatment was implemented. Elements from the prehospital and emergency department records and the first 10 days of intensive care unit (ICU) care were collected. Glasgow Outcome Scores (GOS) were determined every 3 months after discharge.

Results

Over a 3-year period, 145 patients were entered into the study; 81 patients in the Licox group and 64 patients in the Camino group. Mortality, hospital length of stay, and ICU length of stay were equivalent in the 2 groups. More patients in the Licox group achieved a moderate/recovered GOS at 3 months than in the Camino Group (79% vs 61%; P = .09).

Conclusion

Three-month GOS revealed a clinically meaningful 18% benefit in patients undergoing cerebral oxygen monitoring and optimization. Six-month outcomes were also better. Unfortunately, these important differences did not reach significance. Continued study of the benefits of cerebral oxygen monitoring is warranted.

Section snippets

Patients and methods

Patients with severe TBI, defined as a Glasgow Coma Score ≤8, were identified on admission to our Level I trauma center (Miami Valley Hospital, Dayton, OH). Spiral computed tomographic (CT) scans of the brain were reviewed by the neurosurgeon on call who also decided the need for intracranial monitoring. CT findings entered into the study database were assessed retrospectively by an independent radiologist. A polarographic cerebral oxygen monitor (Licox) or fiberoptic ICP monitor (Camino) was

Results

From 2005 to 2008, 145 patients were entered into the study. There were 81 patients in the Licox group and 64 patients in the Camino group. Table I shows that prehospital and emergency department mean Glasgow Coma Score were equivalent between the 2 groups (P = .31 and .11, respectively). There were a greater number of patients with fixed and dilated pupils in the Licox group (23% vs 9%; P = .03). There were no differences in the occurrence of hypotension or desaturation in the emergency

Discussion

Cerebral monitoring in head-injured patients has focused on the prevention of secondary injury to the brain owing to impaired perfusion. However, ICP monitoring does not equal cerebral oxygenation.3 There are currently 4 techniques that can be used to assess cerebral oxygenation—jugular venous oxygen saturation, positron emission tomography, near-infrared spectroscopy, and brain tissue oxygenation monitoring (PbtO2). Their strengths and weaknesses are the subject of several recent reviews.4, 5

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There are more references available in the full text version of this article.

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Partial funding by the Adam Williams Initiative Foundation, Mission Viejo, California.

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