J. C. Haynes1, C. Lawson1, B. Daley1 1University Of Tennessee Medical Canter At Knoxville,Surgery,Knoxville, TN, USA
Introduction: Traumatic Brain Injuries (TBI) cause significant burden on society with an estimated 1.5-2 million injuries with 50,000 associated deaths. Unfortunately there is no true consensus on the best way to treat patients who suffer from severe TBIs. Following brain tissue oxygenation (PtbO2) using special monitors (Licox) has been espoused as beneficial and our center has followed an existing guideline for the last seven years involving close ICP monitoring and in specific patients (chosen by the neurosurgeon) directed therapies to keep PbtO2 greater than 20. We sought to determine if the addition of PbtO2 improved outcome over standard ICP monitoring.
Methods: With IRB approval, a retrospective chart review of the trauma database at a Level 1 center was performed of TBI since 2009. We compared the outcomes of those with had ICP Monitors (‘bolts’ or ventriculostomies) and Licox monitors. We specifically looked at ICU stay, time on the ventilator, length of stay, Injury Severity Scores, and deaths employing T testing and Chi squared analysis.
Results:We found 150 patients meeting inclusion criteria: the Licox group had 41 patients, with an average age of 32, LOS 32.3, ICU days 18.75, vent days 15.9, ISS of 32.6 and 15 deaths. The ICP group had 109 patients, average age of 35.2, LOS 22.3, ICU days 14.8, ISS of 34.5, and 48 deaths. There was no significant difference between the two groups with respect to Age, ICU and Vent days, ISS. There was a difference in the total length of stay; with the ICP group have a shorter LOS. Using Chi-square testing, there was no difference in deaths between groups.
Conclusion: We found that in our current mature treatment schema for TBI, Licox monitors did not improve outcome, but did extend length of stay. Because the Licox paradigm involves aggressive and prolonged mechanical ventilation and frequent transfusion, both known to adversely affect injured patients outcomes, we feel unless its value is validated prospectively, it should be used sparingly.