Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury

Background:A major contributor to unfavorable outcome after traumatic brain injury (TBI) is secondary brain injury. Low brain tissue oxygen tension (PbtO2) has shown to be an independent predictor of unfavorable outcome. Although PbtO2 provides clinicians with an understanding of the ischemic and no...

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Authors: Robba, C, Asgari, S, Gupta, A, Badenes, R, Sekhon, M, Bequiri, E, Hutchinson, PJ, Pelosi, P
Format: article
Status:Published version
Publication Date:2020
Country:España
Institution:INCLIVA
Repository:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p15232
Online Access:https://incliva.portalinvestigacion.com/publicaciones/15232
Access Level:Open access
Keyword:mortality outcome
traumatic brain injury
cerebral oxygenation
partial arterial oxygen pressure
lung injury
hypoxia threshold
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spelling Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain InjuryRobba, CAsgari, SGupta, ABadenes, RSekhon, MBequiri, EHutchinson, PJPelosi, PGupta, Amortality outcometraumatic brain injurycerebral oxygenationpartial arterial oxygen pressurelung injuryhypoxia thresholdBackground:A major contributor to unfavorable outcome after traumatic brain injury (TBI) is secondary brain injury. Low brain tissue oxygen tension (PbtO2) has shown to be an independent predictor of unfavorable outcome. Although PbtO2 provides clinicians with an understanding of the ischemic and non-ischemic derangements of brain physiology, its value does not take into consideration systemic oxygenation that can influence patients' outcomes. This study analyses brain and systemic oxygenation and a number of related indices in TBI patients: PbtO2, partial arterial oxygenation pressure (PaO2), PbtO2/PaO2, ratio of PbtO2 to fraction of inspired oxygen (FiO2), and PaO2/FiO2. The primary aim of this study was to identify independent risk factors for cerebral hypoxia. Secondary goal was to determine whether any of these indices are predictors of mortality outcome in TBI patients. Materials and Methods:A single-centre retrospective cohort study of 70 TBI patients admitted to the Neurocritical Care Unit (NCCU) at Cambridge University Hospital in 2014-2018 and undergoing advanced neuromonitoring including invasive PbtO2 was conducted. Three hundred and three simultaneous measurements of PbtO2, PaO2, PbtO2/PaO2, PbtO2/FiO2, PaO2/FiO2 were collected and mortality at discharge from NCCU was considered as outcome. Generalized estimating equations were used to analyse the longitudinal data. Results:Our results showed PbtO2 of 28 mmHg as threshold to define cerebral hypoxia. PaO2/FiO2 found to be a strong and independent risk factor for cerebral hypoxia when adjusting for confounding factor of intracranial pressure (ICP) with adjusted odds ratio of 1.78, 95% confidence interval of (1.10-2.87) andp-value = 0.019. With respect to TBI outcome, compromised values of PbtO2, PbtO2/PaO2, PbtO2/FiO2, and PaO2/FiO2 were all independent predictors of mortality while considered individually and adjusting for confounding factors of ICP, age, gender, and cerebral perfusion pressure (CPP). However, when considering all the compromised values together, only PaO2/FiO2 became an independent predictor of mortality with adjusted odds ratio of 3.47 (1.20-10.04) andp-value = 0.022. Conclusions:Brain and Lung interaction in TBI patients is a complex interrelationship. PaO2/FiO2 seems to be a major determinant of cerebral hypoxia and mortality. These results confirm the importance of employing ventilator strategies to prevent cerebral hypoxia and improve the outcome in TBI patients.FRONTIERS MEDIA SA2020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/15232Frontiers in NeurologyISSN: 16642295reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p152322026-06-07T16:35:31Z
dc.title.none.fl_str_mv Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury
title Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury
spellingShingle Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury
Robba, C
mortality outcome
traumatic brain injury
cerebral oxygenation
partial arterial oxygen pressure
lung injury
hypoxia threshold
title_short Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury
title_full Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury
title_fullStr Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury
title_full_unstemmed Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury
title_sort Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury
dc.creator.none.fl_str_mv Robba, C
Asgari, S
Gupta, A
Badenes, R
Sekhon, M
Bequiri, E
Hutchinson, PJ
Pelosi, P
Gupta, A
author Robba, C
author_facet Robba, C
Asgari, S
Gupta, A
Badenes, R
Sekhon, M
Bequiri, E
Hutchinson, PJ
Pelosi, P
author_role author
author2 Asgari, S
Gupta, A
Badenes, R
Sekhon, M
Bequiri, E
Hutchinson, PJ
Pelosi, P
author2_role author
author
author
author
author
author
author
dc.subject.none.fl_str_mv mortality outcome
traumatic brain injury
cerebral oxygenation
partial arterial oxygen pressure
lung injury
hypoxia threshold
topic mortality outcome
traumatic brain injury
cerebral oxygenation
partial arterial oxygen pressure
lung injury
hypoxia threshold
description Background:A major contributor to unfavorable outcome after traumatic brain injury (TBI) is secondary brain injury. Low brain tissue oxygen tension (PbtO2) has shown to be an independent predictor of unfavorable outcome. Although PbtO2 provides clinicians with an understanding of the ischemic and non-ischemic derangements of brain physiology, its value does not take into consideration systemic oxygenation that can influence patients' outcomes. This study analyses brain and systemic oxygenation and a number of related indices in TBI patients: PbtO2, partial arterial oxygenation pressure (PaO2), PbtO2/PaO2, ratio of PbtO2 to fraction of inspired oxygen (FiO2), and PaO2/FiO2. The primary aim of this study was to identify independent risk factors for cerebral hypoxia. Secondary goal was to determine whether any of these indices are predictors of mortality outcome in TBI patients. Materials and Methods:A single-centre retrospective cohort study of 70 TBI patients admitted to the Neurocritical Care Unit (NCCU) at Cambridge University Hospital in 2014-2018 and undergoing advanced neuromonitoring including invasive PbtO2 was conducted. Three hundred and three simultaneous measurements of PbtO2, PaO2, PbtO2/PaO2, PbtO2/FiO2, PaO2/FiO2 were collected and mortality at discharge from NCCU was considered as outcome. Generalized estimating equations were used to analyse the longitudinal data. Results:Our results showed PbtO2 of 28 mmHg as threshold to define cerebral hypoxia. PaO2/FiO2 found to be a strong and independent risk factor for cerebral hypoxia when adjusting for confounding factor of intracranial pressure (ICP) with adjusted odds ratio of 1.78, 95% confidence interval of (1.10-2.87) andp-value = 0.019. With respect to TBI outcome, compromised values of PbtO2, PbtO2/PaO2, PbtO2/FiO2, and PaO2/FiO2 were all independent predictors of mortality while considered individually and adjusting for confounding factors of ICP, age, gender, and cerebral perfusion pressure (CPP). However, when considering all the compromised values together, only PaO2/FiO2 became an independent predictor of mortality with adjusted odds ratio of 3.47 (1.20-10.04) andp-value = 0.022. Conclusions:Brain and Lung interaction in TBI patients is a complex interrelationship. PaO2/FiO2 seems to be a major determinant of cerebral hypoxia and mortality. These results confirm the importance of employing ventilator strategies to prevent cerebral hypoxia and improve the outcome in TBI patients.
publishDate 2020
dc.date.none.fl_str_mv 2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/15232
url https://incliva.portalinvestigacion.com/publicaciones/15232
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv FRONTIERS MEDIA SA
publisher.none.fl_str_mv FRONTIERS MEDIA SA
dc.source.none.fl_str_mv Frontiers in Neurology
ISSN: 16642295
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,198674

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