Objective: To investigate the relationship between oxygenation and short-term outcomes in patients with traumatic brain injury (TBI). Design: Logistic regression analysis was used to determine whether average high (Ͼ200 mm Hg) or low (Ͻ100 mm Hg) PaO 2 levels within the first 24 hours of hospital admission correlated with patient outcomes relative to patients with average PaO 2 levels between 100 and 200 mm Hg. Setting: Level 1 trauma center. Patients: We retrospectively reviewed 1547 consecutive patients with severe TBI who survived past 12 hours after hospital admission. Main Outcome Measures: We measured mortality, intensive care unit length of stay, hospital length of stay, and discharge Glasgow Coma Scale (GCS) score. Results: Of the 1547 patients, 77% were male and 89% sustained blunt trauma. Mean (SD) age, admission GCS score, and Injury Severity Score were 41.3 (20.6) years, 8.3 (4.7), and 31.9 (12.5), respectively. Mean (SD) intensive care unit length of stay and hospital length of stay were 8.7(10.5) days and 13.8(13.7) days, respectively. Mean (SD) discharge GCS score was 10.1(4.7). The mortality rate was 28%. After controlling for age, sex, Injury Severity Score, mechanism of injury, and admission GCS score, patients with high PaO 2 levels had significantly higher mortality and lower discharge GCS scores than patients with a normal PaO 2 (P Ͻ.05). Patients with low PaO 2 levels also had increased mortality (P Ͻ.05). Conclusions: Hyperoxia within the first 24 hours of hospitalization is associated with worse short-term functional outcomes and higher mortality after TBI. Although the mechanism for this has not been completely elucidated, it may involve hyperoxia-induced oxygenfree radical toxicity with or without vasoconstriction. Hyperoxia and hypoxia were found to be equally detrimental to short-term outcomes in patients with TBI. A narrower therapeutic window for oxygenation may improve mortality and functional outcomes.

Telemedicine consultation provided treatment options not previously available at the remote hospital. Administration of rtPA during telemedicine consultation was feasible and safe, and the system was well received. Lack of reimbursement for telemedicine services will hinder widespread adaptation of this promising technology for remote acute stroke treatment.

Use of the GlideScope did not influence survival to hospital discharge among all patients and was associated with longer intubation times than direct laryngoscopy. Among the video laryngoscope cohort, a smaller subgroup of severe head injury trauma patients identified retrospectively seemed to be associated with a greater incidence of hypoxia of 80% or less and mortality.

REBOA is a minimally invasive alternative to emergency department thoracotomy with aortic cross-clamp to temporize noncompressible torso hemorrhage and obtain proximal control in both traumatic and nontraumatic causes of hemorrhage. REBOA can also be used for more targeted AO in the distal aorta for pelvic, junctional, or extremity hemorrhage.

Therapeutic, level V.

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III, prognostic study.

No abstract