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Utilization of Brain Tissue Oxygenation Monitoring and Association with Mortality Following Severe Traumatic Brain Injury.

Publication ,  Journal Article
Komisarow, JM; Toro, C; Curley, J; Mills, B; Cho, C; Simo, GM; Vavilala, MS; Laskowitz, DT; James, ML; Mathew, JP; Hernandez, A; Sampson, J ...
Published in: Neurocrit Care
April 2022

BACKGROUND: The aim of this study was to describe the utilization patterns of brain tissue oxygen (PbtO2) monitoring following severe traumatic brain injury (TBI) and determine associations with mortality, health care use, and pulmonary toxicity. METHODS: We conducted a retrospective cohort study of patients from United States trauma centers participating in the American College of Surgeons National Trauma Databank between 2008 and 2016. We examined patients with severe TBI (defined by admission Glasgow Coma Scale score ≤ 8) over the age of 18 years who survived more than 24 h from admission and required intracranial pressure (ICP) monitoring. The primary exposure was PbtO2 monitor placement. The primary outcome was hospital mortality, defined as death during the hospitalization or discharge to hospice. Secondary outcomes were examined to determine the association of PbtO2 monitoring with health care use and pulmonary toxicity and included the following: (1) intensive care unit length of stay, (2) hospital length of stay, and (3) development of acute respiratory distress syndrome (ARDS). Regression analysis was used to assess differences in outcomes between patients exposed to PbtO2 monitor placement and those without exposure by using propensity weighting to address selection bias due to the nonrandom allocation of treatment groups and patient dropout. RESULTS: A total of 35,501 patients underwent placement of an ICP monitor. There were 1,346 (3.8%) patients who also underwent PbtO2 monitor placement, with significant variation regarding calendar year and hospital. Patients who underwent placement of a PbtO2 monitor had a crude in-hospital mortality of 31.1%, compared with 33.5% in patients who only underwent placement of an ICP monitor (adjusted risk ratio 0.84, 95% confidence interval 0.76-0.93). The development of the ARDS was comparable between patients who underwent placement of a PbtO2 monitor and patients who only underwent placement of an ICP monitor (9.2% vs. 9.8%, adjusted risk ratio 0.89, 95% confidence interval 0.73-1.09). CONCLUSIONS: PbtO2 monitor utilization varied widely throughout the study period by calendar year and hospital. PbtO2 monitoring in addition to ICP monitoring, compared with ICP monitoring alone, was associated with a decreased in-hospital mortality, a longer length of stay, and a similar risk of ARDS. These findings provide further guidance for clinicians caring for patients with severe TBI while awaiting completion of further randomized controlled trials.

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Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

April 2022

Volume

36

Issue

2

Start / End Page

350 / 356

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Respiratory Distress Syndrome
  • Neurology & Neurosurgery
  • Monitoring, Physiologic
  • Middle Aged
  • Intracranial Pressure
  • Humans
  • Brain Injuries, Traumatic
  • Brain
  • Adult
 

Citation

APA
Chicago
ICMJE
MLA
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Komisarow, J. M., Toro, C., Curley, J., Mills, B., Cho, C., Simo, G. M., … Krishnamoorthy, V. (2022). Utilization of Brain Tissue Oxygenation Monitoring and Association with Mortality Following Severe Traumatic Brain Injury. Neurocrit Care, 36(2), 350–356. https://doi.org/10.1007/s12028-021-01394-y
Komisarow, Jordan M., Camilo Toro, Jonathan Curley, Brianna Mills, Christopher Cho, Georges Motchoffo Simo, Monica S. Vavilala, et al. “Utilization of Brain Tissue Oxygenation Monitoring and Association with Mortality Following Severe Traumatic Brain Injury.Neurocrit Care 36, no. 2 (April 2022): 350–56. https://doi.org/10.1007/s12028-021-01394-y.
Komisarow JM, Toro C, Curley J, Mills B, Cho C, Simo GM, et al. Utilization of Brain Tissue Oxygenation Monitoring and Association with Mortality Following Severe Traumatic Brain Injury. Neurocrit Care. 2022 Apr;36(2):350–6.
Komisarow, Jordan M., et al. “Utilization of Brain Tissue Oxygenation Monitoring and Association with Mortality Following Severe Traumatic Brain Injury.Neurocrit Care, vol. 36, no. 2, Apr. 2022, pp. 350–56. Pubmed, doi:10.1007/s12028-021-01394-y.
Komisarow JM, Toro C, Curley J, Mills B, Cho C, Simo GM, Vavilala MS, Laskowitz DT, James ML, Mathew JP, Hernandez A, Sampson J, Ohnuma T, Krishnamoorthy V. Utilization of Brain Tissue Oxygenation Monitoring and Association with Mortality Following Severe Traumatic Brain Injury. Neurocrit Care. 2022 Apr;36(2):350–356.
Journal cover image

Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

April 2022

Volume

36

Issue

2

Start / End Page

350 / 356

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Respiratory Distress Syndrome
  • Neurology & Neurosurgery
  • Monitoring, Physiologic
  • Middle Aged
  • Intracranial Pressure
  • Humans
  • Brain Injuries, Traumatic
  • Brain
  • Adult