Effects of brain tissue oxygen (PbtO2) guided management on patient outcomes following severe traumatic brain injury: A systematic review and meta-analysis

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

doi:10.1016/j.jocn.2022.03.017

Effects of brain tissue oxygen (PbtO₂) guided management on patient outcomes following severe traumatic brain injury: A systematic review and meta-analysis

J Clin Neurosci. 2022 May:99:349-358. doi: 10.1016/j.jocn.2022.03.017. Epub 2022 Mar 29.

Authors

Leanne M C Hays¹, Andrew Udy², Alexios A Adamides³, James R Anstey⁴, Michael Bailey⁵, Judith Bellapart⁶, Kathleen Byrne⁷, Andrew Cheng⁸, D Jamie Cooper⁹, Katharine J Drummond¹⁰, Matthias Haenggi¹¹, Stephan M Jakob¹², Alisa M Higgins¹³, Philip M Lewis¹⁴, Martin K Hunn¹⁵, Robert McNamara¹⁶, David K Menon¹⁷, Lynne Murray¹⁸, Benjamin Reddi¹⁹, Tony Trapani²⁰, Shirley Vallance²¹, Paul J Young²², Ramon Diaz-Arrastia²³, Lori Shutter²⁴, Patrick T Murray²⁵, Gerard F Curley²⁶, Alistair Nichol²⁷

Affiliations

¹ University College Dublin Clinical Research Centre, St. Vincent's University Hospital, Dublin, Ireland. Electronic address: leanne.hays@ucd.ie.
² Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia. Electronic address: andrew@udy.com.
³ Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia. Electronic address: Alexios.Adamides@mh.org.au.
⁴ Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia. Electronic address: James.Anstey@mh.org.au.
⁵ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; Department of Medicine and Radiology, University of Melbourne, Victoria, Australia. Electronic address: michael.bailey@monash.edu.
⁶ Department of Intensive Care, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
⁷ Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia. Electronic address: Kathleen.Byrne@mh.org.au.
⁸ Intensive Care Unit, St George Hospital, Gray St, Kogarah, Sydney, NSW, Australia, 2217. Electronic address: Andrew.Cheng@health.nsw.gov.au.
⁹ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia. Electronic address: jamie.cooper@monash.edu.au.
¹⁰ Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia. Electronic address: Kate.Drummond@mh.org.au.
¹¹ Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: Matthias.Haenggi@insel.ch.
¹² Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: Stephan.Jakob@insel.ch.
¹³ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. Electronic address: lisa.higgins@monash.edu.
¹⁴ Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, Victoria, Australia. Electronic address: Philip.Lewis@monash.edu.
¹⁵ Department of Neurosurgery, Alfred Hospital, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia. Electronic address: M.Hunn@alfred.org.au.
¹⁶ Department of Intensive Care, Royal Perth Hospital, Curtin University, Perth, WA, Australia. Electronic address: Robert.Mcnamara@health.wa.gov.au.
¹⁷ Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK. Electronic address: dkm13@cam.ac.uk.
¹⁸ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. Electronic address: lynnette.murray@monash.edu.
¹⁹ Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia; School of Medicine, University of Adelaide, Adelaide, SA, Australia. Electronic address: benjamin.reddi@adelaide.edu.au.
²⁰ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia. Electronic address: tony.trapani@monash.edu.
²¹ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia. Electronic address: Shirley.Vallance@monash.edu.
²² Medical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand. Electronic address: Paul.Young@ccdhb.org.nz.
²³ Department of Neurology and Center for Brain Injury and Repair, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. Electronic address: Ramon.Diaz-Arrastia@pennmedicine.upenn.edu.
²⁴ Department of Critical Care Medicine, University of Pittsburgh School of Medicine / UPMC Health System, Pittsburgh, PA, USA. Electronic address: shutterla@upmc.edu.
²⁵ School of Medicine, University College Dublin, Dublin, Ireland; Clinical Research Centre, University College Dublin, Ireland, Division of Nephrology, Mater Misericordiae University Hospital, Ireland. Electronic address: patrick.murray@ucd.ie.
²⁶ Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland; Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: gercurley@rcsi.ie.
²⁷ University College Dublin Clinical Research Centre, St. Vincent's University Hospital, Dublin, Ireland; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. Electronic address: alistair.nichol@ucd.ie.

PMID: 35364437
DOI: 10.1016/j.jocn.2022.03.017

Abstract

Monitoring and optimisation of brain tissue oxygen tension (PbtO₂) 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 PbtO₂-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 PbtO₂ 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 PbtO₂-guided management (relative risk [RR] 1.42, 95% CI 0.97 to 2.08; p = 0.07; I2 = 0%, very low certainty evidence) but PbtO₂-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. PbtO₂-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.

Keywords: Anaesthesia and intensive care; Multimodality monitoring; Neurology; Physiology and anatomy; Traumatic brain injury.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Brain
Brain Injuries, Traumatic* / therapy
Glasgow Outcome Scale
Humans
Intracranial Pressure*
Oxygen

Substances

Oxygen