Relationship of brain tissue Po2 to outcome after severe head injury

被引:308
作者
Valadka, AB [1 ]
Gopinath, SP [1 ]
Contant, CF [1 ]
Uzura, M [1 ]
Robertson, CS [1 ]
机构
[1] Baylor Coll Med, Dept Neurosurg, Coll Med, Houston, TX 77030 USA
关键词
brain; head injury; human; ischemia; monitoring; outcome; oxygen; survival; threshold; traumatic brain injury;
D O I
10.1097/00003246-199809000-00029
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To determine thresholds of brain tissue Po-2 (PbtO(2)) that are critical for survival after severe head injury. Design: Prospective data collection. Setting: Neurosurgical intensive care unit of Ben Taub General Hospital, a comprehensive academic neurosurgical facility and Level I trauma center. Patients: Forty-three severely head-injured patients who were not obeying commands on presentation or whose condition deteriorated to this level shortly after admission. Interventions: Intracerebral placement of Licox (n = 39) or Paratrend (n = 4) Po-2 probes during craniotomy or in the intensive care unit. Measurements and Main Results: Pbto(2) monitoring continued for an average of 84.6 +/- 41.8 hrs. The probes were calibrated before insertion according to the manufacturer's specifications. After removal, probes were tested in room air and in blood gas standard calibration solutions. Pbto(2) data were analyzed by comparing the average time that Pbto(2) was below the values of 20, 15, 10, 8, 6, 4, and 2 ton (2.7, 2.0, 1.3, 1.0, 0.8, 0.5, and 0.3 kPa, respectively) in patients who were living 3 mos after injury vs. those who died. A Tobit regression analysis using maximum likelihood methods was utilized. Both Licox and Paratrend probes functioned well in room air and in the Level I control. However, in the zero-oxygen solution, the Paratrend probes gave an average reading of 7.0 +/- 1.4 torr (0.9 +/- 0.2 kPa), compared with 0.3 +/- 0.3 torr (0.04 +/- 0.04 kPa) for the Licox probes. Conclusions: Analysis of the PbtO(2) monitoring data suggested that the likelihood of death increased with increasing duration of time at or below a Pbto(2) of 15 torr (2.0 kPa) or with the occurrence of any Pbto(2) values of less than or equal to 6 torr (less than or equal to 0.8 kPa).
引用
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页码:1576 / 1581
页数:6
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