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Brain tissue oxygen guided treatment supplementing ICP/CPP therapy after traumatic brain injury

¹ Klinik für Neurochirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
² Klinik für Neurochirurgie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
³ Neurosurgical Department, Academisch Ziekenhuis Maastricht, Maastricht, Netherlands

Correspondence to:
Correspondence to:
Professor J Meixensberger, Klinik für Neurochirurgie, Universitätsklinikum Leipzig, Johannisallee 34, 04103 Leipzig, Germany;
meix{at}medizin.uni-leipzig.de

Objective: To evaluate the effects of a brain tissue oxygen (P_tiO₂) guided treatment in patients with traumatic brain injury.

Methods: P_tiO₂ was monitored in 93 patients with severe traumatic brain injury. Forty patients admitted from 1993 to 1996 were treated with intracranial pressure/cerebral perfusion pressure (ICP/CPP) management alone (ICP < 20 mm Hg, CPP > 70 mm Hg). Fifty three patients admitted from 1997 to 2000 were treated using ICP/CPP management, but in this second group CPP was also increased as individually required to raise the P_tiO₂ above 1.33 kPa (10 mm Hg) (P_tiO₂ guided group).

Results: Cerebral hypoxic phases with P_tiO₂ values below 1.33 kPa occurred significantly less often in the P_tiO₂ guided group. P_tiO₂ values were higher over the whole monitoring period. No statistical differences could be observed in outcome at six months, despite a positive trend in the P_tiO₂ guided group.

Conclusions: Cerebral hypoxic events can be reduced significantly by increasing cerebral perfusion pressure as required. To show a clear beneficial effect of P_tiO₂ guided cerebral perfusion pressure management on outcome, a multicentre randomised trial needs to be undertaken.

Keywords: brain tissue oxygen; cerebral hypoxia; traumatic brain injury

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