Neurologic outcomes with cerebral oxygen monitoring in traumatic brain injury

McCarthy, Mary C.; Moncrief, Hugh; Sands, Jean M.; Markert, Ronald J.; Hall, Lawrence C.; Wenker, Ian C.; Anderson, Harry L.; Ekeh, A. Peter; Walusimbi, Mbaga S.; Woods, Randy J.; Saxe, Jonathan M.; Tchorz, Kathryn M.

doi:10.1016/j.surg.2009.06.059

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Volume 146, Issue 4 , Pages 585-591, October 2009

Neurologic outcomes with cerebral oxygen monitoring in traumatic brain injury

Mary C. McCarthy, MD
- Division of Trauma, Critical Care and Emergency General Surgery, Department of Surgery, Wright State University School of Medicine, Dayton, OH
- Reprint requests: Mary C. McCarthy, MD, One Wyoming Street, Suite 7000, Miami Valley Hospital, Dayton, OH 45409.
Hugh Moncrief, MD
- Neurosurgical Institute, Inc., Miami Valley Hospital, Dayton, OH
Jean M. Sands, RN
- Clinical Research Centre, Miami Valley Hospital, Dayton, OH
Ronald J. Markert, PhD
- Department of Internal Medicine and Orthopedics, Wright State University School of Medicine, Dayton, OH
Lawrence C. Hall, DO
- Radiology Physicians, Inc., Dayton, OH
Ian C. Wenker, BS
- Department of Emergency Medicine, Wright State University School of Medicine, Dayton, OH
Harry L. Anderson III, MD
- Division of Trauma, Critical Care and Emergency General Surgery, Department of Surgery, Wright State University School of Medicine, Dayton, OH
A. Peter Ekeh, MD
- Division of Trauma, Critical Care and Emergency General Surgery, Department of Surgery, Wright State University School of Medicine, Dayton, OH
Mbaga S. Walusimbi, MD
- Division of Trauma, Critical Care and Emergency General Surgery, Department of Surgery, Wright State University School of Medicine, Dayton, OH
Randy J. Woods, MD
- Division of Trauma, Critical Care and Emergency General Surgery, Department of Surgery, Wright State University School of Medicine, Dayton, OH
Jonathan M. Saxe, MD
- Division of Trauma, Critical Care and Emergency General Surgery, Department of Surgery, Wright State University School of Medicine, Dayton, OH
Kathryn M. Tchorz, MD
- Division of Trauma, Critical Care and Emergency General Surgery, Department of Surgery, Wright State University School of Medicine, Dayton, OH

Accepted 18 June 2009.

Background

Optimizing cerebral oxygenation is advocated to improve outcome in head-injured patients. The purpose of this study was to compare outcomes in brain-injured patients treated with 2 types of monitors.

Methods

Patients with traumatic brain injury and a Glasgow Coma Scale score<8 were identified on admission. A polarographic cerebral oxygen/pressure monitor (Licox) or fiberoptic intracranial pressure monitor (Camino) was inserted. An evidence-based algorithm for treatment was implemented. Elements from the prehospital and emergency department records and the first 10 days of intensive care unit (ICU) care were collected. Glasgow Outcome Scores (GOS) were determined every 3 months after discharge.

Results

Over a 3-year period, 145 patients were entered into the study; 81 patients in the Licox group and 64 patients in the Camino group. Mortality, hospital length of stay, and ICU length of stay were equivalent in the 2 groups. More patients in the Licox group achieved a moderate/recovered GOS at 3 months than in the Camino Group (79% vs 61%; P = .09).

Conclusion

Three-month GOS revealed a clinically meaningful 18% benefit in patients undergoing cerebral oxygen monitoring and optimization. Six-month outcomes were also better. Unfortunately, these important differences did not reach significance. Continued study of the benefits of cerebral oxygen monitoring is warranted.