Brain hypoxia is associated with short-term outcome after severe traumatic brain injury independently of intracranial hypertension and low cerebral perfusion pressure

Mauro Oddo, Joshua M. Levine, Larami MacKenzie, Suzanne Frangos, François Feihl, Scott E. Kasner, Michael Katsnelson, Bryan Pukenas, Eileen MacMurtrie, Eileen Maloney-Wilensky, W. Andrew Kofke, Peter D. Leroux

Research output: Contribution to journalArticle

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Abstract

Background: Brain hypoxia (BH) can aggravate outcome after severe traumatic brain injury (TBI). Whether BH or reduced brain oxygen (Pbto2) is an independent outcome predictor or a marker of disease severity is not fully elucidated. Objective: To analyze the relationship between Pbto2, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) and to examine whether BH correlates with worse outcome independently of ICP and CPP. Methods: We studied 103 patients monitored with ICP and Pbto2 for > 24 hours. Durations of BH (Pbto2 < 15 mm Hg), ICP > 20 mm Hg, and CPP < 60 mm Hg were calculated with linear interpolation, and their associations with outcome within 30 days were analyzed. Results: Duration of BH was longer in patients with unfavorable (Glasgow Outcome Scale score, 1-3) than in those with favorable (Glasgow Outcome Scale, 4-5) outcome (8.3 ± 15.9 vs 1.7 ± 3.7 hours; P < .01). In patients with intracranial hypertension, those with BH had fewer favorable outcomes (46%) than those without (81%; P < .01); similarly, patients with low CPP and BH were less likely to have favorable outcome than those with low CPP but normal Pbto2 (39% vs 83%; P < .01). After ICP, CPP, age, Glasgow Coma Scale score, Marshall computed tomography grade, and Acute Physiology and Chronic Health Evaluation II score were controlled for, BH was independently associated with poor prognosis (adjusted odds ratio for favorable outcome, 0.89 per hour of BH; 95% confidence interval, 0.79-0.99; P = .04). Conclusion: Brain hypoxia is associated with poor short-term outcome after severe traumatic brain injury independently of elevated ICP, low CPP, and injury severity. Pbto2 may be an important therapeutic target after severe traumatic brain injury.

Original languageEnglish
Pages (from-to)1037-1045
Number of pages9
JournalNeurosurgery
Volume69
Issue number5
DOIs
StatePublished - Nov 1 2011

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Cerebrovascular Circulation
Brain Hypoxia
Intracranial Hypertension
Intracranial Pressure
Glasgow Outcome Scale
Traumatic Brain Injury
Glasgow Coma Scale
APACHE

Keywords

  • Brain hypoxia
  • Brain tissue oxygen pressure
  • Cerebral perfusion pressure
  • Indepedent predictor
  • Intracranial Pressure
  • Outcome
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Brain hypoxia is associated with short-term outcome after severe traumatic brain injury independently of intracranial hypertension and low cerebral perfusion pressure. / Oddo, Mauro; Levine, Joshua M.; MacKenzie, Larami; Frangos, Suzanne; Feihl, François; Kasner, Scott E.; Katsnelson, Michael; Pukenas, Bryan; MacMurtrie, Eileen; Maloney-Wilensky, Eileen; Kofke, W. Andrew; Leroux, Peter D.

In: Neurosurgery, Vol. 69, No. 5, 01.11.2011, p. 1037-1045.

Research output: Contribution to journalArticle

Oddo, M, Levine, JM, MacKenzie, L, Frangos, S, Feihl, F, Kasner, SE, Katsnelson, M, Pukenas, B, MacMurtrie, E, Maloney-Wilensky, E, Kofke, WA & Leroux, PD 2011, 'Brain hypoxia is associated with short-term outcome after severe traumatic brain injury independently of intracranial hypertension and low cerebral perfusion pressure', Neurosurgery, vol. 69, no. 5, pp. 1037-1045. https://doi.org/10.1227/NEU.0b013e3182287ca7
Oddo, Mauro ; Levine, Joshua M. ; MacKenzie, Larami ; Frangos, Suzanne ; Feihl, François ; Kasner, Scott E. ; Katsnelson, Michael ; Pukenas, Bryan ; MacMurtrie, Eileen ; Maloney-Wilensky, Eileen ; Kofke, W. Andrew ; Leroux, Peter D. / Brain hypoxia is associated with short-term outcome after severe traumatic brain injury independently of intracranial hypertension and low cerebral perfusion pressure. In: Neurosurgery. 2011 ; Vol. 69, No. 5. pp. 1037-1045.
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abstract = "Background: Brain hypoxia (BH) can aggravate outcome after severe traumatic brain injury (TBI). Whether BH or reduced brain oxygen (Pbto2) is an independent outcome predictor or a marker of disease severity is not fully elucidated. Objective: To analyze the relationship between Pbto2, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) and to examine whether BH correlates with worse outcome independently of ICP and CPP. Methods: We studied 103 patients monitored with ICP and Pbto2 for > 24 hours. Durations of BH (Pbto2 < 15 mm Hg), ICP > 20 mm Hg, and CPP < 60 mm Hg were calculated with linear interpolation, and their associations with outcome within 30 days were analyzed. Results: Duration of BH was longer in patients with unfavorable (Glasgow Outcome Scale score, 1-3) than in those with favorable (Glasgow Outcome Scale, 4-5) outcome (8.3 ± 15.9 vs 1.7 ± 3.7 hours; P < .01). In patients with intracranial hypertension, those with BH had fewer favorable outcomes (46{\%}) than those without (81{\%}; P < .01); similarly, patients with low CPP and BH were less likely to have favorable outcome than those with low CPP but normal Pbto2 (39{\%} vs 83{\%}; P < .01). After ICP, CPP, age, Glasgow Coma Scale score, Marshall computed tomography grade, and Acute Physiology and Chronic Health Evaluation II score were controlled for, BH was independently associated with poor prognosis (adjusted odds ratio for favorable outcome, 0.89 per hour of BH; 95{\%} confidence interval, 0.79-0.99; P = .04). Conclusion: Brain hypoxia is associated with poor short-term outcome after severe traumatic brain injury independently of elevated ICP, low CPP, and injury severity. Pbto2 may be an important therapeutic target after severe traumatic brain injury.",
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T1 - Brain hypoxia is associated with short-term outcome after severe traumatic brain injury independently of intracranial hypertension and low cerebral perfusion pressure

AU - Oddo, Mauro

AU - Levine, Joshua M.

AU - MacKenzie, Larami

AU - Frangos, Suzanne

AU - Feihl, François

AU - Kasner, Scott E.

AU - Katsnelson, Michael

AU - Pukenas, Bryan

AU - MacMurtrie, Eileen

AU - Maloney-Wilensky, Eileen

AU - Kofke, W. Andrew

AU - Leroux, Peter D.

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N2 - Background: Brain hypoxia (BH) can aggravate outcome after severe traumatic brain injury (TBI). Whether BH or reduced brain oxygen (Pbto2) is an independent outcome predictor or a marker of disease severity is not fully elucidated. Objective: To analyze the relationship between Pbto2, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) and to examine whether BH correlates with worse outcome independently of ICP and CPP. Methods: We studied 103 patients monitored with ICP and Pbto2 for > 24 hours. Durations of BH (Pbto2 < 15 mm Hg), ICP > 20 mm Hg, and CPP < 60 mm Hg were calculated with linear interpolation, and their associations with outcome within 30 days were analyzed. Results: Duration of BH was longer in patients with unfavorable (Glasgow Outcome Scale score, 1-3) than in those with favorable (Glasgow Outcome Scale, 4-5) outcome (8.3 ± 15.9 vs 1.7 ± 3.7 hours; P < .01). In patients with intracranial hypertension, those with BH had fewer favorable outcomes (46%) than those without (81%; P < .01); similarly, patients with low CPP and BH were less likely to have favorable outcome than those with low CPP but normal Pbto2 (39% vs 83%; P < .01). After ICP, CPP, age, Glasgow Coma Scale score, Marshall computed tomography grade, and Acute Physiology and Chronic Health Evaluation II score were controlled for, BH was independently associated with poor prognosis (adjusted odds ratio for favorable outcome, 0.89 per hour of BH; 95% confidence interval, 0.79-0.99; P = .04). Conclusion: Brain hypoxia is associated with poor short-term outcome after severe traumatic brain injury independently of elevated ICP, low CPP, and injury severity. Pbto2 may be an important therapeutic target after severe traumatic brain injury.

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KW - Brain tissue oxygen pressure

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KW - Indepedent predictor

KW - Intracranial Pressure

KW - Outcome

KW - Traumatic brain injury

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