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Association of Early Myocardial Workload and Mortality Following Severe Traumatic Brain Injury.

Publication ,  Journal Article
Krishnamoorthy, V; Vavilala, MS; Chaikittisilpa, N; Rivara, FP; Temkin, NR; Lele, AV; Gibbons, EF; Rowhani-Rahbar, A
Published in: Crit Care Med
June 2018

OBJECTIVES: To examine the impact of early myocardial workload on in-hospital mortality following isolated severe traumatic brain injury. DESIGN: Retrospective cohort study. SETTING: Data from the National Trauma Databank, a multicenter trauma registry operated by the American College of Surgeons, from 2007 to 2014. PATIENTS: Adult patients with isolated severe traumatic brain injury (defined as admission Glasgow Coma Scale < 8 and head Abbreviated Injury Score ≥ 4). INTERVENTIONS: Admission rate-pressure product, categorized into five levels based on published low, normal, and submaximal human thresholds: less than 5,000; 5,000-9,999; 10,000-14,999; 15,000-19,999; and greater than 20,000. MEASUREMENTS AND MAIN RESULTS: Data from 26,412 patients were analyzed. Most patients had a normal rate-pressure product (43%), 35% had elevated rate-pressure product, and 22% had depressed rate-pressure product at hospital admission. Compared with the normal rate-pressure product group, in-hospital mortality was 22 percentage points higher in the lowest rate-pressure product group (cumulative mortality, 50.2%; 95% CI, 43.6-56.9%) and 11 percentage points higher in the highest rate-pressure product group (cumulative mortality, 39.2%; 95% CI, 37.4-40.9%). The lowest rate-pressure product group was associated with a 50% increased risk of mortality, compared with the normal rate-pressure product group (adjusted relative risk, 1.50; 95% CI, 1.31-1.76%; p < 0.0001), and the highest rate-pressure product group was associated with a 25% increased risk of mortality, compared with the normal rate-pressure product group (adjusted relative risk, 1.25; 95% CI, 1.18-1.92%; p < 0.0001). This relationship was blunted with increasing age. Among patients with normotension, those with depressed and elevated rate-pressure products experienced increased mortality. CONCLUSIONS: Adults with severe traumatic brain injury experience heterogeneous myocardial workload profiles that have a "U-shaped" relationship with mortality, even in the presence of a normal blood pressure. Our findings are novel and suggest that cardiac performance is important following severe traumatic brain injury.

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Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

June 2018

Volume

46

Issue

6

Start / End Page

965 / 971

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Risk Factors
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Hospital Mortality
  • Heart Rate
  • Heart
 

Citation

APA
Chicago
ICMJE
MLA
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Krishnamoorthy, V., Vavilala, M. S., Chaikittisilpa, N., Rivara, F. P., Temkin, N. R., Lele, A. V., … Rowhani-Rahbar, A. (2018). Association of Early Myocardial Workload and Mortality Following Severe Traumatic Brain Injury. Crit Care Med, 46(6), 965–971. https://doi.org/10.1097/CCM.0000000000003052
Krishnamoorthy, Vijay, Monica S. Vavilala, Nophanan Chaikittisilpa, Frederick P. Rivara, Nancy R. Temkin, Abhijit V. Lele, Edward F. Gibbons, and Ali Rowhani-Rahbar. “Association of Early Myocardial Workload and Mortality Following Severe Traumatic Brain Injury.Crit Care Med 46, no. 6 (June 2018): 965–71. https://doi.org/10.1097/CCM.0000000000003052.
Krishnamoorthy V, Vavilala MS, Chaikittisilpa N, Rivara FP, Temkin NR, Lele AV, et al. Association of Early Myocardial Workload and Mortality Following Severe Traumatic Brain Injury. Crit Care Med. 2018 Jun;46(6):965–71.
Krishnamoorthy, Vijay, et al. “Association of Early Myocardial Workload and Mortality Following Severe Traumatic Brain Injury.Crit Care Med, vol. 46, no. 6, June 2018, pp. 965–71. Pubmed, doi:10.1097/CCM.0000000000003052.
Krishnamoorthy V, Vavilala MS, Chaikittisilpa N, Rivara FP, Temkin NR, Lele AV, Gibbons EF, Rowhani-Rahbar A. Association of Early Myocardial Workload and Mortality Following Severe Traumatic Brain Injury. Crit Care Med. 2018 Jun;46(6):965–971.

Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

June 2018

Volume

46

Issue

6

Start / End Page

965 / 971

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Risk Factors
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Hospital Mortality
  • Heart Rate
  • Heart