{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:48:44Z","timestamp":1791899324635,"version":"4.3.4"},"reference-count":67,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2009,10]]},"abstract":"\n Object<\/jats:title>\n \n Cerebral ischemia is the leading cause of preventable death in cases of major trauma with severe traumatic brain injury (TBI). Intracranial pressure (ICP) control and cerebral perfusion pressure (CPP) manipulation have significantly reduced the mortality but not the morbidity rate in these patients. In this study, the authors describe their 5-year experience with brain tissue oxygen (PbtO\n 2<\/jats:sub>\n ) monitoring, and the effect of a brain tissue oxygen\u2013directed critical care guide (PbtO\n 2<\/jats:sub>\n -CCG) on the 6-month clinical outcome (based on the 6-month Glasgow Outcome Scale score) in patients with TBIs.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n One hundred thirty-nine patients admitted to Creighton University Medical Center with major traumatic injuries (Injury Severity Scale [ISS] scores \u2265 16) and TBI underwent prospective evaluation. All patients were treated with a PbtO\n 2<\/jats:sub>\n -CCG to maintain a brain oxygen level > 20 mm Hg, and control ICP < 20 mm Hg. The role of demographic, clinical, and imaging parameters in the identification of patients at risk for cerebral hypooxygenation and the influence of hypooxygenation on clinical outcome were recorded. Outcomes were compared with those in a historical ICP\/CPP patient cohort. Subgroup analysis of severe TBI was performed and compared to data reported in the Traumatic Coma Data Bank.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The majority of injuries were sustained in motor vehicle crashes (63%), and diffuse brain injury was the most common abnormality (58%). Mechanism of injury, severity of TBI, pathological entity, neuroimaging results, and trauma indices were not predictive of ischemia. Factors affecting death included gunshot injury, poor trauma indices, subarachnoid hemorrhage, and coma. After standard resuscitation, 65% of patients had an initially low PbtO\n 2<\/jats:sub>\n . Data are presented as means \u00b1 SDs. Treatment with the PbtO\n 2<\/jats:sub>\n -CCG resulted in a 44% improvement in mean PbtO\n 2<\/jats:sub>\n (16.21 \u00b1 12.30 vs 23.65 \u00b1 14.40 mm Hg; p < 0.001), control of ICP (mean 12.76 \u00b1 6.42 mm Hg), and the maintenance of CPP (mean 76.13 \u00b1 15.37 mm Hg). Persistently low cerebral oxygenation was seen in 37% of patients at 2 hours, 31% at 24 hours, and 18% at 48 hours of treatment. Thus elevated ICP and a persistent low PbtO\n 2<\/jats:sub>\n after 2 hours represented increasing odds of death (OR 14.3 at 48 hours). Survivors and patients with good outcomes generally had significantly higher mean daily PbtO\n 2<\/jats:sub>\n and CPP values compared to nonsurvivors. Polytrauma, associated with higher ISS scores, presented an increased risk of vegetative outcome (OR 9.0). Compared to the ICP\/CPP cohort, the mean Glasgow Outcome Scale score at 6 months in patients treated with PbtO\n 2<\/jats:sub>\n -CCG was higher (3.55 \u00b1 1.75 vs 2.71 \u00b1 1.65, p < 0.01; OR for good outcome 2.09, 95% CI 1.031\u20134.24) as was the reduction in mortality rate (25.9 vs 41.50%; relative risk reduction 37%), despite higher ISS scores in the PbtO\n 2<\/jats:sub>\n group (31.6 \u00b1 13.4 vs 27.1 \u00b1 8.9; p < 0.05). Subgroup analysis of severe closed TBI revealed a significant relative risk reduction in mortality rate of 37\u201351% compared with the Traumatic Coma Data Bank data, and an increased OR for good outcome especially in patients with diffuse brain injury without mass lesions (OR 4.9, 95% CI 2.9\u20138.4).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The prevention and aggressive treatment of cerebral hypooxygenation and control of ICP with a PbtO\n 2<\/jats:sub>\n -directed protocol reduced the mortality rate after TBI in major trauma, but more importantly, resulted in improved 6-month clinical outcomes over the standard ICP\/CPP-directed therapy at the authors' institution.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2009.4.jns081150","type":"journal-article","created":{"date-parts":[[2009,5,22]],"date-time":"2009-05-22T09:55:26Z","timestamp":1242986126000},"page":"672-682","source":"Crossref","is-referenced-by-count":240,"title":["Brain tissue oxygen monitoring in traumatic brain injury and major trauma: outcome analysis of a brain tissue oxygen\u2013directed therapy"],"prefix":"10.3171","volume":"111","author":[{"given":"Pradeep K.","family":"Narotam","sequence":"first","affiliation":[{"name":"Union Hospital Neuroscience, Terre Haute, Indiana;"},{"name":"Divisions of Neurosurgery and"},{"name":"Trauma, Creighton University Medical Center, Omaha, Nebraska; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F.","family":"Morrison","sequence":"additional","affiliation":[{"name":"Divisions of Neurosurgery and"},{"name":"Trauma, Creighton University Medical Center, Omaha, Nebraska; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narendra","family":"Nathoo","sequence":"additional","affiliation":[{"name":"Divisions of Neurosurgery and"},{"name":"Trauma, Creighton University Medical Center, Omaha, Nebraska; and"},{"name":"Alegent Health Neuroscience Specialists, Council Bluffs, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-1110672","series-title":"Crit Care","first-page":"638","article-title":"Cerebral perfusion pressure and brain ischaemia: can one size fit all?","volume":"9","author":"Andrews","year":"2005"},{"key":"b2-1110672","series-title":"J Trauma","first-page":"1010","article-title":"Prevalence and prognosis of traumatic intraventricular hemorrhage in patients with blunt head trauma","volume":"60","author":"Atzema","year":"2006"},{"key":"b3-1110672","series-title":"Neurocrit Care","first-page":"8","article-title":"Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury","volume":"4","author":"Balestreri","year":"2006"},{"key":"b4-1110672","series-title":"Acta Neurochir Suppl","first-page":"153","article-title":"Monitoring of brain tissue PO2 in traumatic brain injury: effect of cerebral hypoxia on outcome","volume":"71","author":"Bardt","year":"1998"},{"key":"b5-1110672","series-title":"J Neurosurg","first-page":"491","article-title":"The outcome from severe head injury with early diagnosis and intensive management","volume":"47","author":"Becker","year":"1977"},{"key":"b6-1110672","series-title":"Acta Neurochir Suppl","first-page":"111","article-title":"Effects of cerebral perfusion pressure on brain tissue PO2 in patients with severe head injury","volume":"71","author":"Bruzzone","year":"1998"},{"key":"b7-1110672","series-title":"Crit Care Med","first-page":"1870","article-title":"Management of severe head injury: institutional variations in care and effect on outcome","volume":"30","author":"Bulger","year":"2002"},{"key":"b8-1110672","series-title":"Minerva Chir","first-page":"1467","article-title":"Severe head trauma. Review of the factors influencing the prognosis","volume":"52","author":"Celli","year":"1997"},{"key":"b9-1110672","series-title":"New Horiz","first-page":"366","article-title":"Secondary brain insults after head injury: clinical perspectives","volume":"3","author":"Chesnut","year":"1995"},{"key":"b10-1110672","series-title":"Curr Opin Crit Care","first-page":"120","article-title":"Regional ischemia after head injury","volume":"10","author":"Coles","year":"2004"},{"key":"b11-1110672","series-title":"Brain","first-page":"2479","article-title":"Does induced hypertension reduce cerebral ischaemia within the traumatized human brain?","volume":"127","author":"Coles","year":"2004"},{"key":"b12-1110672","series-title":"J Neurosurg","first-page":"9","article-title":"Elevated jugular venous oxygen saturation after severe head injury","volume":"90","author":"Cormio","year":"1999"},{"key":"b13-1110672","series-title":"Crit Care Med","first-page":"2207","article-title":"Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury","volume":"33","author":"Cremer","year":"2005"},{"key":"b14-1110672","series-title":"J Trauma","first-page":"868","article-title":"Early prediction of mortality in isolated head injury patients: a new predictive model","volume":"61","author":"Demetriades","year":"2006"},{"key":"b15-1110672","series-title":"Neurosurgery","first-page":"1082","article-title":"Clinical experience with 118 brain tissue oxygen partial pressure catheter probes","volume":"43","author":"Dings","year":"1998"},{"key":"b16-1110672","series-title":"J Clin Neurosci","first-page":"226","article-title":"Cerebral oxygenation and systemic trauma-related factors determining neurological outcome after brain injury","volume":"7","author":"Fandino","year":"2000"},{"key":"b17-1110672","series-title":"Neurosurg Rev","first-page":"94","article-title":"Brain tissue pO2 related to SjvO2, ICP, and CPP in severe brain injury","volume":"23","author":"Filippi","year":"2000"},{"key":"b18-1110672","series-title":"Curr Opin Crit Care","first-page":"115","article-title":"Advanced monitoring in the intensive care unit: brain tissue oxygen tension","volume":"8","author":"Haitsma","year":"2002"},{"issue":"2 Suppl","key":"b19-1110672","series-title":"Surg Neurol","first-page":"S8","article-title":"Subdural intracranial pressure monitoring in severe head injury: clinical experience with the Codman MicroSensor","volume":"66","author":"Hong","year":"2006"},{"key":"b20-1110672","series-title":"J Clin Neurosci","first-page":"818","article-title":"Clinical outcome of severe head injury using three different ICP and CPP protocol-driven therapies","volume":"13","author":"Huang","year":"2006"},{"key":"b21-1110672","series-title":"Acta Neurochir (Wien)","first-page":"51","article-title":"Correlation of continuously monitored regional cerebral blood flow and brain tissue oxygen","volume":"147","author":"Jaeger","year":"2005"},{"key":"b22-1110672","series-title":"Crit Care Med","first-page":"189","article-title":"Effect of cerebral perfusion pressure augmentation on regional oxygenation and metabolism after head injury","volume":"33","author":"Johnston","year":"2005"},{"key":"b23-1110672","series-title":"Neurol Res","first-page":"233","article-title":"Brain tissue pO2-monitoring in comatose patients: implications for therapy","volume":"19","author":"Kiening","year":"1997"},{"key":"b24-1110672","series-title":"Acta Neurochir Suppl","first-page":"172","article-title":"Bifrontal measurements of brain tissue-PO2 in comatose patients","volume":"71","author":"Kiening","year":"1998"},{"key":"b25-1110672","series-title":"J Neurosurg","first-page":"751","article-title":"Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue PO2 versus jugular vein oxygen saturation","volume":"85","author":"Kiening","year":"1996"},{"key":"b26-1110672","series-title":"Can J Surg","first-page":"442","article-title":"Intracranial pressure monitoring and outcomes after traumatic brain injury","volume":"43","author":"Lane","year":"2000"},{"key":"b27-1110672","series-title":"Arch Surg","first-page":"1118","article-title":"Hypotension, hypoxia, and head injury: frequency, duration, and consequences","volume":"136","author":"Manley","year":"2001"},{"key":"b28-1110672","series-title":"J Trauma","first-page":"1025","article-title":"Cerebral oxygenation during hemorrhagic shock: perils of hyperventilation and the therapeutic potential of hypoventilation","volume":"48","author":"Manley","year":"2000"},{"key":"b29-1110672","series-title":"J Neurosurg","first-page":"952","article-title":"ICP monitoring in severe head injury","volume":"67","author":"Marshall","year":"1987"},{"issue":"Suppl","key":"b30-1110672","series-title":"J Neurosurg","first-page":"S28","article-title":"The outcome of severe closed head injury","volume":"75","author":"Marshall","year":"1991"},{"key":"b31-1110672","series-title":"J Neurosurg","first-page":"519","article-title":"A multicenter trial on the efficacy of using tirilazad mesylate in cases of head injury","volume":"89","author":"Marshall","year":"1998"},{"issue":"1 Suppl","key":"b32-1110672","series-title":"J Neurotrauma","first-page":"S287","article-title":"The diagnosis of head injury requires a classification based on computed axial tomography","volume":"9","author":"Marshall","year":"1992"},{"key":"b33-1110672","series-title":"J Neurosurg","first-page":"20","article-title":"The outcome with aggressive treatment in severe head injuries. Part I: the significance of intracranial pressure monitoring","volume":"50","author":"Marshall","year":"1979"},{"key":"b34-1110672","series-title":"J Neurosurg","first-page":"26","article-title":"The outcome with aggressive treatment in severe head injuries. Part II: acute and chronic barbiturate administration in the management of head injury","volume":"50","author":"Marshall","year":"1979"},{"key":"b35-1110672","series-title":"Arch Phys Med Rehabil","first-page":"1198","article-title":"Hyperbaric oxygen therapy for traumatic brain injury: a systematic review of the evidence","volume":"85","author":"McDonagh","year":"2004"},{"key":"b36-1110672","series-title":"J Neurosurg","first-page":"1","article-title":"Increased inspired oxygen concentration as a factor in improved brain tissue oxygenation and tissue lactate levels after severe human head injury","volume":"91","author":"Menzel","year":"1999"},{"key":"b37-1110672","series-title":"J Neurosurg","first-page":"289","article-title":"Further experience in the management of severe head injury","volume":"54","author":"Miller","year":"1981"},{"key":"b38-1110672","series-title":"J Pediatr Surg","first-page":"505","article-title":"Cerebral oxygenation in major pediatric trauma: its relevance to trauma severity and outcome","volume":"41","author":"Narotam","year":"2006"},{"key":"b39-1110672","series-title":"J Neurosurg","first-page":"1065","article-title":"Management of hypertensive emergencies in acute brain disease: evaluation of the treatment effects of intravenous nicardipine on cerebral oxygenation","volume":"109","author":"Narotam","year":"2008"},{"key":"b40-1110672","series-title":"Restor Neurol Neurosci","first-page":"83","article-title":"New perspectives in neurotrauma research","volume":"14","author":"Neugebauer","year":"1999"},{"key":"b41-1110672","series-title":"Ann Acad Med Singapore","first-page":"332","article-title":"Outcome of patients with traumatic brain injury managed on a standardised head injury protocol","volume":"27","author":"Ng","year":"1998"},{"key":"b42-1110672","series-title":"J Neurosurg","first-page":"439","article-title":"Cerebral circulation after head injury. Part 4: Functional anatomy and boundary-zone flow deprivation in the first week of traumatic coma","volume":"59","author":"Overgaard","year":"1983"},{"key":"b43-1110672","series-title":"J Trauma","first-page":"657","article-title":"The impact on outcomes in a community hospital setting of using the AANS traumatic brain injury guidelines. American Associations for Neurologic Surgeons","volume":"50","author":"Palmer","year":"2001"},{"key":"b44-1110672","series-title":"Lancet","first-page":"1538","article-title":"Trends in head injury outcome from 1989 to 2003 and the effect of neurosurgical care: an observational study","volume":"366","author":"Patel","year":"2005"},{"key":"b45-1110672","series-title":"Acta Neurochir (Wien)","first-page":"341","article-title":"Effects of cerebral perfusion pressure and increased fraction of inspired oxygen on brain tissue oxygen, lactate and glucose in patients with severe head injury","volume":"145","author":"Reinert","year":"2003"},{"key":"b46-1110672","series-title":"J Head Trauma Rehabil","first-page":"368","article-title":"Mortality and morbidity from moderate to severe traumatic brain injury in Argentina","volume":"20","author":"Rondina","year":"2005"},{"key":"b47-1110672","series-title":"Acta Neurochir Suppl","first-page":"457","article-title":"Does an increase in cerebral perfusion pressure always mean a better oxygenated brain? A study in head-injured patients","volume":"76","author":"Sahuquillo","year":"2000"},{"key":"b48-1110672","series-title":"Acta Neurochir Suppl","first-page":"186","article-title":"Cerebral oxygenation in contusioned vs. nonlesioned brain tissue: monitoring of PtiO2 with Licox and Paratrend","volume":"71","author":"Sarrafzadeh","year":"1998"},{"key":"b49-1110672","series-title":"Br J Neurosurg","first-page":"340","article-title":"Metabolic changes during impending and manifest cerebral hypoxia in traumatic brain injury","volume":"17","author":"Sarrafzadeh","year":"2003"},{"key":"b50-1110672","series-title":"Crit Care Med","first-page":"1116","article-title":"Secondary insults in severe head injury\u2014do multiply injured patients do worse?","volume":"29","author":"Sarrafzadeh","year":"2001"},{"key":"b51-1110672","series-title":"Acta Neurochir Suppl","first-page":"62","article-title":"Influence of hyperventilation on brain tissue-PO2, PCO2, and pH in patients with intracranial hypertension","volume":"71","author":"Schneider","year":"1998"},{"key":"b52-1110672","series-title":"Cochrane Database Syst Rev","first-page":"CD001048","article-title":"Therapeutic hypothermia for head injury","volume":"2","author":"Signorini","year":"2000"},{"key":"b53-1110672","series-title":"J Neurosurg","first-page":"805","article-title":"Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring","volume":"103","author":"Stiefel","year":"2005"},{"key":"b54-1110672","series-title":"J Neurosurg","first-page":"568","article-title":"Conventional neurocritical care and cerebral oxygenation after traumatic brain injury","volume":"105","author":"Stiefel","year":"2006"},{"key":"b55-1110672","series-title":"Acta Neurochir Suppl","first-page":"162","article-title":"High cerebral perfusion pressure improves low values of local brain tissue O2 tension (PtiO2) in focal lesions","volume":"71","author":"Stocchetti","year":"1998"},{"key":"b56-1110672","series-title":"Intensive Care Med","first-page":"400","article-title":"Intensive care management of head-injured patients in Europe: a survey from the European Brain Injury Consortium","volume":"27","author":"Stocchetti","year":"2001"},{"key":"b57-1110672","series-title":"Lancet","first-page":"81","article-title":"Assessment of coma and impaired consciousness. A practical scale","volume":"2","author":"Teasdale","year":"1974"},{"key":"b58-1110672","series-title":"Crit Care Med","first-page":"1576","article-title":"Relationship of brain tissue PO2 to outcome after severe head injury","volume":"26","author":"Valadka","year":"1998"},{"key":"b59-1110672","series-title":"Acta Neurochir Suppl","first-page":"190","article-title":"Monitoring brain oxygen tension in severe head injury: the Rotterdam experience","volume":"71","author":"van den Brink","year":"1998"},{"key":"b60-1110672","series-title":"Neurosurgery","first-page":"868","article-title":"Brain oxygen tension in severe head injury","volume":"46","author":"van den Brink","year":"2000"},{"key":"b61-1110672","series-title":"Neurosurgery","first-page":"21","article-title":"Continuous monitoring of partial pressure of brain tissue oxygen in patients with severe head injury","volume":"38","author":"van Santbrink","year":"1996"},{"key":"b62-1110672","series-title":"Acta Neurochir (Wien)","first-page":"1141","article-title":"Serial transcranial Doppler measurements in traumatic brain injury with special focus on the early posttraumatic period","volume":"144","author":"van Santbrink","year":"2002"},{"key":"b63-1110672","series-title":"Acta Neurochir (Wien)","first-page":"429","article-title":"Brain tissue oxygen response in severe traumatic brain injury","volume":"145","author":"van Santbrink","year":"2003"},{"key":"b64-1110672","series-title":"Aust N Z J Surg","first-page":"527","article-title":"Severe head injury management in a general surgical department","volume":"64","author":"Visvanathan","year":"1994"},{"key":"b65-1110672","series-title":"Acta Neurochir (Wien)","first-page":"1203","article-title":"The effect of implementation of guidelines for the management of severe head injury on patient treatment and outcome","volume":"141","author":"Vukic","year":"1999"},{"key":"b66-1110672","series-title":"Chin J Traumatol","first-page":"93","article-title":"Prospective survey on neurosurgical intensive care for patients with severe head injury","volume":"4","author":"Yang","year":"2001"},{"key":"b67-1110672","series-title":"Surg Neurol","first-page":"393","article-title":"Continuous monitoring of brain tissue oxygen pressure in patients with severe head injury during moderate hypothermia","volume":"52","author":"Zhi","year":"1999"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/111\/4\/article-p672.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/111\/4\/article-p672.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/111\/4\/article-p672.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T05:14:11Z","timestamp":1679894051000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/111\/4\/article-p672.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2009,10]]},"references-count":67,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2009.4.jns081150","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.1165808.628874","asserted-by":"object"}]},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,10]]}}}