Prognostic value of near-infrared spectroscopy regional oxygen saturation and cerebrovascular reactivity index in acute traumatic neural injury: a CAnadian High-Resolution Traumatic Brain Injury (CAHR-TBI) Cohort Study

• Published in: Critical care (London, England) Vol. 28; no. 1; p. 78
• Main Authors: Gomez, Alwyn, Froese, Logan, Griesdale, Donald, Thelin, Eric P, Raj, Rahul, van Iperenburg, Levi, Tas, Jeanette, Aries, Marcel, Stein, Kevin Y, Gallagher, Clare, Bernard, Francis, Kramer, Andreas H, Zeiler, Frederick A
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 14.03.2024; BioMed Central
• Subjects: Analysis; Blood; Brain; Brain research; Clinical outcomes; Cohort analysis; Collaboration; Data collection; Health aspects; Injuries; Intensive care; Intracranial pressure; Medical prognosis; Medicin och hälsovetenskap; Near infrared spectroscopy; Oxygen saturation; Patients; Research ethics; Software; Spectrum analysis; Time series; Traumatic brain injury; Canada; Minneapolis Minnesota; United States > US; Multimodal monitoring; Cerebrovascular reactivity; Traumatic brain injury; Near-infrared spectroscopy
• ISSN: 1364-8535; 1466-609X; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-024-04859-6

Near-infrared spectroscopy regional cerebral oxygen saturation (rSO ) has gained interest as a raw parameter and as a basis for measuring cerebrovascular reactivity (CVR) due to its noninvasive nature and high spatial resolution. However, the prognostic utility of these parameters has not yet been determined. This study aimed to identify threshold values of rSO and rSO -based CVR at which outcomes worsened following traumatic brain injury (TBI). A retrospective multi-institutional cohort study was performed. The cohort included TBI patients treated in four adult intensive care units (ICU). The cerebral oxygen indices, COx (using rSO and cerebral perfusion pressure) as well as COx_a (using rSO and arterial blood pressure) were calculated for each patient. Grand mean thresholds along with exposure-based thresholds were determined utilizing sequential chi-squared analysis and univariate logistic regression, respectively. In the cohort of 129 patients, there was no identifiable threshold for raw rSO at which outcomes were found to worsen. For both COx and COx_a, an optimal grand mean threshold value of 0.2 was identified for both survival and favorable outcomes, while percent time above - 0.05 was uniformly found to have the best discriminative value. In this multi-institutional cohort study, raw rSO was found to contain no significant prognostic information. However, rSO -based indices of CVR, COx and COx_a, were found to have a uniform grand mean threshold of 0.2 and exposure-based threshold of - 0.05, above which clinical outcomes markedly worsened. This study lays the groundwork to transition to less invasive means of continuously measuring CVR.