Physiologic and functional outcome correlates of brain tissue hypoxia in traumatic brain injury

Jason Chang, Teddy S. Youn, Dan Benson, Heather Mattick, Nicholas Andrade, Caryn R. Harper, Carol B. Moore, Christopher J. Madden, Ramon R. Diaz-Arrastia

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

OBJECTIVE:: Assess the prevalence of brain tissue hypoxia in patients with severe traumatic brain injuries (TBI), and to characterize the relationship between brain tissue hypoxia and functional outcome. DESIGN:: Retrospective review of severe TBI patients. SETTING:: Intensive care unit of a level I trauma center. PATIENTS:: Twenty-seven patients with severe TBI requiring intracranial pressure (ICP) monitoring. Median age was 22 yrs, and a majority (63%) had traumatic subarachnoid hemorrhage. INTERVENTIONS:: Hourly assessments of ICP, brain tissue oxygen, mean arterial pressure, fraction of inspired oxygen (Fio2), partial pressure of arterial carbon dioxide (Paco2), and hemoglobin concentration (hemoglobin) were recorded. Outcome was assessed 6-9 months postinjury. MEASUREMENTS AND MAIN RESULTS:: Mean (sd) ICP and BTpo2 were 13.7 (6.6) cm H2O and 30.8 (13.6) mm Hg. A total of 13.5% (379) of the BTpo2 values recorded were 20% of the time had poorer scores on outcome measures compared with those with fewer hypoxic epochs. CONCLUSIONS:: Hypoxic episodes are common after severe TBI, and most are independent of ICP elevations. Most episodes of hypoxia occur while cerebral perfusion pressure and mean arterial pressure are within the accepted target range. There is no clear association between Paco2 and hemoglobin with BTpo2. The young age and high prevalence of traumatic subarachnoid hemorrhage in this cohort may limit its generalizability. Increased frequency of hypoxic episodes is associated with poor functional outcome.

Original languageEnglish (US)
Pages (from-to)283-290
Number of pages8
JournalCritical Care Medicine
Volume37
Issue number1
DOIs
StatePublished - Jan 2009
Externally publishedYes

Fingerprint

Brain Hypoxia
Intracranial Pressure
Traumatic Subarachnoid Hemorrhage
Hemoglobins
Cerebrovascular Circulation
Arterial Pressure
Oxygen
Intracranial Hypertension
Partial Pressure
Trauma Centers
Carbon Dioxide
Intensive Care Units
Outcome Assessment (Health Care)
Traumatic Brain Injury
Brain

Keywords

  • Brain tissue oxygenation
  • Cerebral perfusion pressure
  • Hemoglobin
  • Intracranial pressure
  • PaCO traumatic brain injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Chang, J., Youn, T. S., Benson, D., Mattick, H., Andrade, N., Harper, C. R., ... Diaz-Arrastia, R. R. (2009). Physiologic and functional outcome correlates of brain tissue hypoxia in traumatic brain injury. Critical Care Medicine, 37(1), 283-290. https://doi.org/10.1097/CCM.0b013e318192fbd7

Physiologic and functional outcome correlates of brain tissue hypoxia in traumatic brain injury. / Chang, Jason; Youn, Teddy S.; Benson, Dan; Mattick, Heather; Andrade, Nicholas; Harper, Caryn R.; Moore, Carol B.; Madden, Christopher J.; Diaz-Arrastia, Ramon R.

In: Critical Care Medicine, Vol. 37, No. 1, 01.2009, p. 283-290.

Research output: Contribution to journalArticle

Chang, J, Youn, TS, Benson, D, Mattick, H, Andrade, N, Harper, CR, Moore, CB, Madden, CJ & Diaz-Arrastia, RR 2009, 'Physiologic and functional outcome correlates of brain tissue hypoxia in traumatic brain injury', Critical Care Medicine, vol. 37, no. 1, pp. 283-290. https://doi.org/10.1097/CCM.0b013e318192fbd7
Chang, Jason ; Youn, Teddy S. ; Benson, Dan ; Mattick, Heather ; Andrade, Nicholas ; Harper, Caryn R. ; Moore, Carol B. ; Madden, Christopher J. ; Diaz-Arrastia, Ramon R. / Physiologic and functional outcome correlates of brain tissue hypoxia in traumatic brain injury. In: Critical Care Medicine. 2009 ; Vol. 37, No. 1. pp. 283-290.
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