Temporal Patterns in Brain Tissue and Systemic Oxygenation Associated with Mortality After Severe Traumatic Brain Injury in Children

Background Brain tissue hypoxia is an independent risk factor for unfavorable outcomes in traumatic brain injury (TBI); however, systemic hyperoxemia encountered in the prevention and/or response to brain tissue hypoxia may also impact risk of mortality. We aimed to identify temporal patterns of partial pressure of oxygen in brain tissue ($ PbtO_{2} $), partial pressure of arterial oxygen ($ PaO_{2} $), and $ PbtO_{2} $/$ PaO_{2} $ ratio associated with mortality in children with severe TBI. Methods Data were extracted from the electronic medical record of a quaternary care children’s hospital with a level I trauma center for patients ≤ 18 years old with severe TBI and the presence of $ PbtO_{2} $ and/or intracranial pressure monitors. Temporal analyses were performed for the first 5 days of hospitalization by using locally estimated scatterplot smoothing for less than 1,000 observations and generalized additive models with integrated smoothness estimation for more than 1,000 observations. Results A total of 138 intracranial pressure–monitored patients with TBI (median 5.0 [1.9–12.8] years; 65% boys; admission Glasgow Coma Scale score 4 [3–7]; mortality 18%), 71 with $ PbtO_{2} $ monitors and 67 without $ PbtO_{2} $ monitors were included. Distinct patterns in $ PbtO_{2} $, $ PaO_{2} $, and $ PbtO_{2} $/$ PaO_{2} $ were evident between survivors and nonsurvivors over the first 5 days of hospitalization. Time-series analyses showed lower $ PbtO_{2} $ values on day 1 and days 3–5 and lower $ PbtO_{2} $/$ PaO_{2} $ ratios on days 1, 2, and 5 among patients who died. Analysis of receiver operating characteristics curves using Youden’s index identified a $ PbtO_{2} $ of 30 mm Hg and a $ PbtO_{2} $/$ PaO_{2} $ ratio of 0.12 as the cut points for discriminating between survivors and nonsurvivors. Univariate logistic regression identified $ PbtO_{2} $ < 30 mm Hg, hyperoxemia ($ PaO_{2} $ ≥ 300 mm Hg), and $ PbtO_{2} $/$ PaO_{2} $ ratio < 0.12 to be independently associated with mortality. Conclusions Lower $ PbtO_{2} $, higher $ PaO_{2} $, and lower $ PbtO_{2} $/$ PaO_{2} $ ratio, consistent with impaired oxygen diffusion into brain tissue, were associated with mortality in this cohort of children with severe TBI. These results corroborate our prior work that suggests targeting a higher $ PbtO_{2} $ threshold than recommended in current guidelines and highlight the potential use of the $ PbtO_{2} $/$ PaO_{2} $ ratio in the management of severe pediatric TBI..

Medienart:	Artikel

Erscheinungsjahr:	2022
Erschienen:	2022

Enthalten in:	Zur Gesamtaufnahme - volume:38
Enthalten in:	Neurocritical care - 38(2022), 1 vom: 28. Sept., Seite 71-84

Sprache:	Englisch

Beteiligte Personen:	Rakkar, Jaskaran [VerfasserIn] Azar, Justin [VerfasserIn] Pelletier, Jonathan H. [VerfasserIn] Au, Alicia K. [VerfasserIn] Bell, Michael J. [VerfasserIn] Simon, Dennis W. [VerfasserIn] Kochanek, Patrick M. [VerfasserIn] Clark, Robert S. B. [VerfasserIn] Horvat, Christopher M. [VerfasserIn]

Links:	Volltext [lizenzpflichtig]

Themen:	Brain tissue oxygenation Mortality Pediatrics Systemic oxygenation Traumatic brain injury

Anmerkungen:	© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:	10.1007/s12028-022-01602-3

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PPN (Katalog-ID):	OLC2133988556