NYMC Faculty Publications

The Impact of Early Flow and Brain Oxygen Crisis on the Outcome of Patients With Severe Traumatic Brain Injury

Author Type(s)

Faculty

DOI

10.1016/j.amjsurg.2014.08.003

Journal Title

American Journal of Surgery

First Page

1071

Last Page

1077

Document Type

Article

Publication Date

12-1-2014

Department

Surgery

Keywords

Adult, Brain, Brain Injuries, Critical Care, Female, Hospital Mortality, Humans, Intracranial Pressure, Male, Middle Aged, Monitoring, Physiologic, Oxygen, Spectroscopy, Near-Infrared, Treatment Outcome

Disciplines

Medicine and Health Sciences

Abstract

BACKGROUND: Multimodality monitoring and goal-directed therapy may not prevent blood flow and brain oxygen (Flow/BrOx) crisis. We sought to determine the impact of these events on outcome in patients with severe traumatic brain injury (sTBI).

METHODS: Twenty-four patients with sTBI were treated to maintain intracranial pressure (ICP) less than or equal to 20 mm Hg, cerebral perfusion pressure (CPP) greater than or equal to 60 mm Hg, brain oxygen greater than or equal to 20 mm Hg, and near infrared spectroscopy greater than or equal to 60%. Flow/BrOx crisis events were recorded. The 14-day predicted mortality was compared with actual mortality.

RESULTS: Nonsurvivors had a significantly higher number of crisis events nonresponsive to treatment (P < .05). Mortality was 87.5% in patients with greater than or equal to 20 events versus 6.3% in patients with less than 20 events. The predicted mortality was 58%, whereas actual mortality was 33.3% (8/24), yielding a 42% reduction in mortality.

CONCLUSIONS: A multimodality monitoring and goal-directed therapy may decrease mortality in sTBI. However, Flow/BrOx crisis events still occur and predict a poor outcome.

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