Brain tissue oxygen partial pressure monitoring and prognosis of patients with traumatic brain injury: a meta-analysis

• Published in: Neurosurgical review Vol. 47; no. 1; p. 222
• Main Authors: Shen, Yuqi, Wen, Dan, Liang, Zhenghua, Wan, Li, Jiang, Qingli, He, Haiyan, He, Mei
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 17.05.2024
• Subjects: Brain; Brain Injuries, Traumatic - diagnosis; Brain Injuries, Traumatic - mortality; Brain Injuries, Traumatic - therapy; Cerebrovascular Circulation - physiology; Humans; Intracranial Pressure - physiology; Length of Stay; Medicine; Medicine & Public Health; Monitoring, Physiologic - methods; Neurosurgery; Oxygen - blood; Oxygen - metabolism; Partial Pressure; Prognosis; Review; Traumatic brain injury; Intracranial pressure; Cerebral perfusion pressure; Brain tissue oxygen monitoring; Meta-analysis
• ISSN: 1437-2320; 0344-5607; 1437-2320
• DOI: 10.1007/s10143-024-02439-4

To assess whether monitoring brain tissue oxygen partial pressure (PbtO 2 ) or employing intracranial pressure (ICP)/cerebral perfusion pressure (CCP)-guided management improves patient outcomes, including mortality, hospital length of stay (LOS), mean daily ICP and mean daily CCP during the intensive care unit(ICU)stay. We searched the Web of Science, EMBASE, PubMed, Cochrane Library, and MEDLINE databases until December 12, 2023. Prospective randomized controlled and cohort studies were included. A meta-analysis was performed for the primary outcome measure, mortality, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eleven studies with a total of 37,492 patients were included. The mortality in the group with PbtO 2 was 29.0% (odds ratio: 0.73;95% confidence interval [CI]:0.56–0.96; P = 0.03; I = 55%), demonstrating a significant benefit. The overall hospital LOS was longer in the PbtO 2 group than that in the ICP/CPP group (mean difference:2.03; 95% CI:1.03–3.02; P<0.0001; I = 39%). The mean daily ICP in the PbtO 2 monitoring group was lower than that in the ICP/CPP group (mean difference:-1.93; 95% CI: -3.61 to -0.24; P = 0.03; I = 41%). Moreover, PbtO 2 monitoring did not improve the mean daily CPP (mean difference:2.43; 95%CI: -1.39 to 6.25;P = 0.21; I = 56%).Compared with ICP/CPP monitoring, PbtO 2 monitoring reduced the mortality and the mean daily ICP in patients with severe traumatic brain injury; however, no significant effect was noted on the mean daily CPP. In contrast, ICP/CPP monitoring alone was associated with a short hospital stay.