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Brain tissue oxygen plus intracranial pressure monitoring versus isolated intracranial pressure monitoring in patients with traumatic brain injury: an updated meta-analysis of randomized controlled trials.
Pustilnik, Hugo Nunes; Medrado-Nunes, Gabriel Souza; Cerqueira, Gabriel Araújo; Meira, Davi Amorim; da Cunha, Beatriz Lopes Bernardo; Porto Junior, Silvio; Fontes, Jefferson Heber Marques; da Silva da Paz, Matheus Gomes; Alcântara, Tancredo; de Avellar, Leonardo Miranda.
Afiliação
  • Pustilnik HN; Salvador University, Salvador, Brazil. hugonpustilnik@gmail.com.
  • Medrado-Nunes GS; Federal University of Bahia, Salvador, Brazil.
  • Cerqueira GA; Bahiana School of Medicine and Public Health, Salvador, Brazil.
  • Meira DA; Bahiana School of Medicine and Public Health, Salvador, Brazil.
  • da Cunha BLB; University of Bahia State, Salvador, Brazil.
  • Porto Junior S; Bahiana School of Medicine and Public Health, Salvador, Brazil.
  • Fontes JHM; Metropolitan Union of Education and Culture, Salvador, Brazil.
  • da Silva da Paz MG; Neurosurgery Department, General Hospital Roberto Santos, Salvador, Brazil.
  • Alcântara T; Neurosurgery Department, General Hospital Roberto Santos, Salvador, Brazil.
  • de Avellar LM; Neurosurgery Department, General Hospital Roberto Santos, Salvador, Brazil.
Acta Neurochir (Wien) ; 166(1): 240, 2024 May 30.
Article em En | MEDLINE | ID: mdl-38814348
ABSTRACT

BACKGROUND:

Intracranial pressure (ICP) monitoring plays a key role in patients with traumatic brain injury (TBI), however, cerebral hypoxia can occur without intracranial hypertension. Aiming to improve neuroprotection in these patients, a possible alternative is the association of Brain Tissue Oxygen Pressure (PbtO2) monitoring, used to detect PbtO2 tension.

METHOD:

We systematically searched PubMed, Embase and Cochrane Central for RCTs comparing combined PbtO2 + ICP monitoring with ICP monitoring alone in patients with severe or moderate TBI. The outcomes analyzed were mortality at 6 months, favorable outcome (GOS ≥ 4 or GOSE ≥ 5) at 6 months, pulmonary events, cardiovascular events and sepsis rate.

RESULTS:

We included 4 RCTs in the analysis, totaling 505 patients. Combined PbtO2 + ICP monitoring was used in 241 (47.72%) patients. There was no significant difference between the groups in relation to favorable outcome at 6 months (RR 1.17; 95% CI 0.95-1.43; p = 0.134; I2 = 0%), mortality at 6 months (RR 0.82; 95% CI 0.57-1.18; p = 0.281; I2 = 34%), cardiovascular events (RR 1.75; 95% CI 0.86-3.52; p = 0.120; I2 = 0%) or sepsis (RR 0.75; 95% CI 0.25-2.22; p = 0.604; I2 = 0%). The risk of pulmonary events was significantly higher in the group with combined PbtO2 + ICP monitoring (RR 1.44; 95% CI 1.11-1.87; p = 0.006; I2 = 0%).

CONCLUSIONS:

Our findings suggest that combined PbtO2 + ICP monitoring does not change outcomes such as mortality, functional recovery, cardiovascular events or sepsis. Furthermore, we found a higher risk of pulmonary events in patients undergoing combined monitoring.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pressão Intracraniana / Ensaios Clínicos Controlados Aleatórios como Assunto / Lesões Encefálicas Traumáticas Limite: Humans Idioma: En Revista: Acta Neurochir (Wien) Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Áustria
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pressão Intracraniana / Ensaios Clínicos Controlados Aleatórios como Assunto / Lesões Encefálicas Traumáticas Limite: Humans Idioma: En Revista: Acta Neurochir (Wien) Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Áustria