首页|Effects of brain tissue oxygen (PbtO(2)) guided management on patient outcomes following severe traumatic brain injury: A systematic review and meta-analysis

Effects of brain tissue oxygen (PbtO(2)) guided management on patient outcomes following severe traumatic brain injury: A systematic review and meta-analysis

扫码查看
原文链接
  • NSTL
  • Elsevier
Monitoring and optimisation of brain tissue oxygen tension (PbtO(2)) has been associated with improved neurological outcome and survival in observational studies of severe traumatic brain injury (TBI). We carried out a systematic review of randomized controlled trials to determine if PbtO(2)-guided management is associated with differential neurological outcomes, survival, and adverse events. Searches were carried out to 10 February 2022 in Medline (OvidSP), 11 February in EMBASE (OvidSP) and 8 February in Cochrane library. Randomized controlled trials comparing PbtO(2) and ICP-guided management to ICP-guided management alone were included. The primary outcome was survival with favourable neurological outcome at 6-months post injury. Data were extracted by two independent authors and GRADE certainty of evidence assessed. There was no difference in the proportion of patients with favourable neurological outcomes with PbtO(2)-guided management (relative risk [RR] 1.42, 95% CI 0.97 to 2.08; p = 0.07; I2 = 0%, very low certainty evidence) but PbtO(2)-guided management was associated with reduced mortality (RR 0.54, 95% CI 0.31 to 0.93; p = 0.03; I2 = 42%; very low certainty evidence) and ICP (mean difference (MD) -4.62, 95% CI -8.27 to -0.98; p = 0.01; I2 = 63%; very low certainty evidence). There was no significant difference in the risk of adverse respiratory or cardiovascular events. PbtO(2)- guided management in addition to ICP-based care was not significantly associated with increased favourable neurological outcomes, but was associated with increased survival and reduced ICP, with no difference in respiratory or cardiovascular adverse events. However, based on GRADE criteria, the certainty of evidence provided by this meta-analysis was consistently very low. MESH: Brain Ischemia; Intensive Care; Glasgow Outcome Scale; Randomized Controlled Trial; Craniocerebral Trauma.

Anaesthesia and intensive careNeurologyPhysiology and anatomyTraumatic brain injuryMultimodality monitoringSEVERE HEAD-INJURYINTRACRANIAL-PRESSURECEREBRAL OXYGENATIONTHERAPYEPIDEMIOLOGYMETABOLISMMORTALITYTENSION

Hays, Leanne M. C.、Udy, Andrew、Adamides, Alexios A.、Anstey, James R.、Bailey, Michael、Bellapart, Judith、Byrne, Kathleen、Cheng, Andrew、Cooper, D. Jamie、Drummond, Katharine J.、Haenggi, Matthias、Jakob, Stephan M.、Higgins, Alisa M.、Lewis, Philip M.、Hunn, Martin K.、McNamara, Robert、Menon, David K.、Murray, Lynne、Reddi, Benjamin、Trapani, Tony、Vallance, Shirley、Young, Paul J.、Diaz-Arrastia, Ramon、Shutter, Lori、Murray, Patrick T.、Curley, Gerard F.、Nichol, Alistair

展开 >

University College Dublin,Univ Coll Dublin

Australian & New Zealand Intens Care Res Ctr,Monash Univ

Dept Neurosurg,Royal Melbourne Hosp

Intens Care Unit,Royal Melbourne Hosp

Dept Intens Care,Royal Brisbane & Womens Hosp

Intens Care Unit,St George Hosp

Bern Univ Hosp,Univ Bern

Dept Elect & Comp Syst Engn,Monash Univ

Dept Neurosurg,Alfred Hosp

Royal Perth Hosp,Curtin Univ

Addenbrookes Hosp,Univ Cambridge

Intens Care Unit,Royal Adelaide Hosp

Med Res Inst New Zealand

Perelman Sch Med,Univ Penn

Dept Crit Care Med,Univ Pittsburgh

Sch Med,Univ Coll Dublin

Royal Coll Surg Ireland,Beaumont Hosp

展开 >

2022

10.1016/j.jocn.2022.03.017

Journal of clinical neuroscience

Journal of clinical neuroscience

SCI
ISSN：0967-5868
年,卷(期)：2022.99
  • 8
  • 38