Brain tissue oxygen–directed management and outcome in patients with severe traumatic brain injury

Spiotta, Alejandro M; Stiefel, Michael F.; Gracias, Vicente H.; Garuffe, Alicia; Kofke, W. Andrew; Maloney-Wilensky, Eileen; Troxel, Andrea B.; Levine, Joshua M.; Roux, Peter D. Le

doi:10.3171/2010.1.jns09506

Cited by 216 publications

(127 citation statements)

References 57 publications

(94 reference statements)

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“…Indeed, the use of management schemes that incorporate vigorous CPP augmentation can result in significant cardiorespiratory complications (Robertson et al, 1999). Further, there is accumulating evidence that the optimum level of CPP varies between patients, and the optimum level in a given patient may be identifiable using autoregulatory indices (Howells et al, 2005;Steiner et al, 2002), or brain oximetry (Spiotta et al, 2010).…”

Section: Individualizing Clinical Managementmentioning

confidence: 99%

Re-Orientation of Clinical Research in Traumatic Brain Injury: Report of an International Workshop on Comparative Effectiveness Research

Maas

Menon

Lingsma

et al. 2012

Journal of Neurotrauma

163

134

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During the National Neurotrauma Symposium 2010, the DG Research of the European Commission and the National Institutes of Health/National Institute of Neurological Disorders and Stroke (NIH/NINDS) organized a workshop on comparative effectiveness research (CER) in traumatic brain injury (TBI). This workshop reviewed existing approaches to improve outcomes of TBI patients. It had two main outcomes: First, it initiated a process of re-orientation of clinical research in TBI. Second, it provided ideas for a potential collaboration between the European Commission and the NIH/NINDS to stimulate research in TBI. Advances in provision of care for TBI patients have resulted from observational studies, guideline development, and meta-analyses of individual patient data. In contrast, randomized controlled trials have not led to any identifiable major advances. Rigorous protocols and tightly selected populations constrain generalizability. The workshop addressed additional research approaches, summarized the greatest unmet needs, and highlighted priorities for future research. The collection of high-quality clinical databases, associated with systems biology and CER, offers substantial opportunities. Systems biology aims to identify multiple factors contributing to a disease and addresses complex interactions. Effectiveness research aims to measure benefits and risks of systems of care and interventions in ordinary settings and broader populations. These approaches have great potential for TBI research. Although not new, they still need to be introduced to and accepted by TBI researchers as instruments for clinical research. As with therapeutic targets in individual patient management, so it is with research tools: one size does not fit all.

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Section: Individualizing Clinical Managementmentioning

confidence: 99%

Re-Orientation of Clinical Research in Traumatic Brain Injury: Report of an International Workshop on Comparative Effectiveness Research

Maas

Menon

Lingsma

et al. 2012

Journal of Neurotrauma

163

134

View full text Add to dashboard Cite

show abstract

“…In observational studies comparing historical cohorts with P btO 2 -managed subjects, data show mortality and functional outcome benefits. [99][100][101] However, many single-center studies have not demonstrated this benefit. In a study with 93 subjects, Meixensberger et al 102 compared P btO 2 -directed therapy with cerebral perfusion pressure-directed therapy and found no difference between groups.…”

Section: Limitationsmentioning

confidence: 99%

Brain Tissue Oxygen Monitoring and the Intersection of Brain and Lung: A Comprehensive Review

2016

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SummaryTraumatic brain injury is a problem that affects millions of Americans yearly and for which there is no definitive treatment that improves outcome. Continuous brain tissue oxygen (P btO 2 ) monitoring is a complement to traditional brain monitoring techniques, such as intracranial pressure and cerebral perfusion pressure. P btO 2 monitoring has not yet become a clinical standard of care, due to several unresolved questions. In this review, we discuss the rationale and technology of P btO 2 monitoring. We review the literature, both historic and current, and show that continuous P btO 2 monitoring is feasible and useful in patient management. P btO 2 numbers reflect cerebral blood flow and oxygen diffusion. Thus, continuous monitoring of P btO 2 yields important information about both the brain and the lung. The preclinical and clinical studies demonstrating these findings are discussed. In this review, we demonstrate that patient management in a P btO 2 -directed fashion is not the sole answer to the problem of treating traumatic brain injury but is an important adjunct to the armamentarium of multimodal neuromonitoring.

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“…The current recommendation for a treatment threshold to maintain PbO 2 above 20 mmHg is based on a paucity of outcome data, which include the widespread use of historical controls. This is reflected in the strength of the recommendation for their widespread use [27,28]. More recently a prospectively randomized single-center trial comparing the addition of PbO 2 monitoring and targeted treatment to a protocol based on the established guidelines found no difference in mortality or functional outcome [29].…”

Section: Pbo 2 and Metabolism Monitoringmentioning

confidence: 99%

ICU Management of Traumatic Brain Injury

Hallman

Joffe

2013

Curr Anesthesiol Rep

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Traumatic brain injury (TBI) is a major cause of death and disability throughout the world. Injury can be divided into primary and secondary injuries. For patients with TBI admitted to the intensive care unit (ICU), the management and prevention of secondary injury is most important. The third edition of the Brain Trauma Foundation guidelines was published in 2007 and is widely used to guide treatment of patients with severe TBI. This article reviews ICU care of patients with severe TBI, with a particular focus on recent evidence that is not incorporated in the existing guidelines.

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Brain tissue oxygen–directed management and outcome in patients with severe traumatic brain injury

Abstract: These results suggest that PbtO(2)-based therapy, particularly when compromised PbtO(2) can be corrected, may be associated with reduced patient mortality and improved patient outcome after severe TBI.

Cited by 216 publications

References 57 publications

Re-Orientation of Clinical Research in Traumatic Brain Injury: Report of an International Workshop on Comparative Effectiveness Research

Re-Orientation of Clinical Research in Traumatic Brain Injury: Report of an International Workshop on Comparative Effectiveness Research

Brain Tissue Oxygen Monitoring and the Intersection of Brain and Lung: A Comprehensive Review

ICU Management of Traumatic Brain Injury

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