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.

doi:10.1227/neu.0b013e3182287ca7

Cited by 155 publications

(92 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…9,13,14,18,20,21,24,26 The specific composition of any clinical data set is therefore highly variable. This points toward the complexity of TBI, and it becomes highly difficult if not impossible to control or correct for any one of these confounding variables in outcome prediction.…”

Section: Discussionmentioning

confidence: 99%

Short pressure reactivity index versus long pressure reactivity index in the management of traumatic brain injury

Lang

Kasprowicz

Smielewski

et al. 2015

JNS

View full text Add to dashboard Cite

A rteriAl blood pressure (ABP), intracranial pressure (ICP), cerebral blood flow velocity measured with transcranial Doppler ultrasonography, and cerebral microcirculation assessed by laser Doppler flow are periodical biological signals that can be continuously monitored and recorded in both routine and ICU settings by using invasive and noninvasive techniques and devices. 5,12,16,30,32 These biological signals will show frequency peaks within certain frequency bands.6,11 They can be categorized into two groups: 1) the B waves that occur at approximately 0.5-3 cycles per minute, which corresponds to a frequency of 0.008-0.05 Hz;5,16,23 and 2) M waves, which occur at approximately 4-9 cycles per minute, which corresponds to a frequency of 0.07-0.15 Hz. 7,12,22 The 6 ventiabbreviatioNs ABP = arterial blood pressure; CPPopt = optimal cerebral perfusion pressure; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICP = intracranial pressure; IQR = interquartile range; L-PRx = long pressure reactivity index; PVS = persistent vegetative state; TBI = traumatic brain injury. obJect The pressure reactivity index (PRx) correlates with outcome after traumatic brain injury (TBI) and is used to calculate optimal cerebral perfusion pressure (CPPopt). The PRx is a correlation coefficient between slow, spontaneous changes (0.003-0.05 Hz) in intracranial pressure (ICP) and arterial blood pressure (ABP). A novel index-the so-called long PRx (L-PRx)-that considers ABP and ICP changes (0.0008-0.008 Hz) was proposed. methods The authors compared PRx and L-PRx for 6-month outcome prediction and CPPopt calculation in 307 patients with TBI. The PRx- and L-PRx-based CPPopt were determined and the predictive power and discriminant abilities were compared. results The PRx and L-PRx correlation was good (R = 0.7, p < 0.00001; Spearman test). The PRx, age, CPP, and Glasgow Coma Scale score but not L-PRx were significant fatal outcome predictors (death and persistent vegetative state). There was a significant difference between the areas under the receiver operating characteristic curves calculated for PRx and L-PRx (0.61 ± 0.04 vs 0.51 ± 0.04; z-statistic = -3.26, p = 0.011), which indicates a better ability by PRx than L-PRx to predict fatal outcome. The CPPopt was higher for L-PRx than for PRx, without a statistical difference (median CPPopt for L-PRx: 76.9 mm Hg, interquartile range [IQR] ± 10.1 mm Hg; median CPPopt for PRx: 74.7 mm Hg, IQR ± 8.2 mm Hg). Death was associated with CPP below CPPopt for PRx (c 2 = 30.6, p < 0.00001), and severe disability was associated with CPP above CPPopt for PRx (c 2 = 7.8, p = 0.005). These relationships were not statistically significant for CPPopt for L-PRx. coNclusioNs The PRx is superior to the L-PRx for TBI outcome prediction. Individual CPPopt for L-PRx and PRx are not statistically different. Deviations between CPP and CPPopt for PRx are relevant for outcome prediction; those between CPP and CPPopt for L-PRx are not. The PRx uses the entire B-wave spectrum for index calculation, whereas the ...

show abstract

Section: Discussionmentioning

confidence: 99%

Short pressure reactivity index versus long pressure reactivity index in the management of traumatic brain injury

Lang

Kasprowicz

Smielewski

et al. 2015

JNS

View full text Add to dashboard Cite

show abstract

“…It is not possible to do a CT scan in all patients with STBI because some of them are clinically very unstable and therefore not transportable to the CT scan facility [4], Most findings were intracranial or intracerebral hemorrhages (62.98%) and depressed skull fractures (22.22%). In their study, Oddo et al [21] report that 79% of patients in their series had traumatic SAH or intraventricular hemorrhage on admission CT scan.…”

Section: Ct Scan Findingsmentioning

confidence: 93%

Epidemiological Analysis of 135 Cases of Severe Traumatic Brain Injury Managed at a Surgical Intensive Care Unit

Ndoumbe¹,

Edu²,

Simeu³

et al. 2018

OJMN

View full text Add to dashboard Cite

This study was a retrospective analysis of the epidemiologic profile of severe traumatic brain injuries managed at the surgical intensive care unit of the University Hospital Center of Yaoundé, Cameroon, between January 2011 and December 2015. All the patients admitted at the surgical intensive care unit for a traumatic brain injury with an initial Glasgow coma scale score ≤ 8 were included. One hundred and thirty-five cases were enrolled. One hundred and fourteen were males and 21 were females. Their mean age was 32.75 years. Forty-four patients were aged between 16 to 30 years. Road traffic accidents represented the first mode of injury with 101 cases and most of the patients were pedestrians hit by a car. Pupils and students were the most involved. Twenty-three patients had additional extracranial injury. On admission, 97 (71.85%) patients had GCS 7-8. A brain CT scan was done for 115 patients. Intracranial and intracerebral hemorrhages were the most frequent radiological findings with 57 cases. The overall mortality was 32.59% with 44 deaths. Thirty-two of the deaths occurred in patients with GCS 7 -8 on admission. Ninety-one (67.40%) patients survived, 74 (54.81%) had persisting disabilities, while only 17 (12.59%) recovered fully. The following factors had an impact on the outcome: GCS at admission, pupillary anomalies, length of hospital stay, endotracheal intubation and surgery. Severe TBI remains a heavy socio-economic burden worldwide. In Cameroon where the health system is poorly organized, the outcome of individuals who sustained a severe TBI was dismal.

show abstract

“…Adequate function of mitochondria is pivotal for the survival and activity of all brain cells, and even brief periods of oxygen or glucose deprivation could shut down brain functions within seconds, damaging neurons within minutes. 4 Abundant data from retrospective studies and prospective clinical trials have shown brain hypoxia to be an early predictor of adverse outcomes after TBI, [5][6][7] because efficient ATP production by the mitochondrial respiratory chain relies on continuous oxygen supply.…”

Section: Traumatic Brain Injury (Tbi)mentioning

confidence: 99%

Low-Level Light in Combination with Metabolic Modulators for Effective Therapy of Injured Brain

Dong

Zhang

Hamblin

et al. 2015

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

Vascular damage occurs frequently at the injured brain causing hypoxia and is associated with poor outcomes in the clinics. We found high levels of glycolysis, reduced adenosine triphosphate generation, and increased formation of reactive oxygen species and apoptosis in neurons under hypoxia. Strikingly, these adverse events were reversed significantly by noninvasive exposure of injured brain to low-level light (LLL). Low-level light illumination sustained the mitochondrial membrane potential, constrained cytochrome c leakage in hypoxic cells, and protected them from apoptosis, underscoring a unique property of LLL. The effect of LLL was further bolstered by combination with metabolic substrates such as pyruvate or lactate both in vivo and in vitro. The combinational treatment retained memory and learning activities of injured mice to a normal level, whereas other treatment displayed partial or severe deficiency in these cognitive functions. In accordance with well-protected learning and memory function, the hippocampal region primarily responsible for learning and memory was completely protected by combination treatment, in marked contrast to the severe loss of hippocampal tissue because of secondary damage in control mice. These data clearly suggest that energy metabolic modulators can additively or synergistically enhance the therapeutic effect of LLL in energyproducing insufficient tissue-like injured brain.

show abstract

Brain Hypoxia Is Associated With Short-term Outcome After Severe Traumatic Brain Injury Independently of Intracranial Hypertension and Low Cerebral Perfusion Pressure

Abstract: Brain hypoxia is associated with poor short-term outcome after severe traumatic brain injury independently of elevated ICP, low CPP, and injury severity. Pbto(2) may be an important therapeutic target after severe traumatic brain injury.

Cited by 155 publications

References 43 publications

Short pressure reactivity index versus long pressure reactivity index in the management of traumatic brain injury

Short pressure reactivity index versus long pressure reactivity index in the management of traumatic brain injury

Epidemiological Analysis of 135 Cases of Severe Traumatic Brain Injury Managed at a Surgical Intensive Care Unit

Low-Level Light in Combination with Metabolic Modulators for Effective Therapy of Injured Brain

Contact Info

Product

Resources

About