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

Objective: To evaluate the effects of a brain tissue oxygen (PtiO2) guided treatment in patients with traumatic brain injury. Methods: PtiO2 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 PtiO2 above 1.33 kPa (10 mm Hg) (PtiO2 guided group). Results: Cerebral hypoxic phases with PtiO2 values below 1.33 kPa occurred significantly less often in the PtiO2 guided group. PtiO2 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 PtiO2 guided group. Conclusions: Cerebral hypoxic events can be reduced significantly by increasing cerebral perfusion pressure as required. To show a clear beneficial effect of PtiO2 guided cerebral perfusion pressure management on outcome, a multicentre randomised trial needs to be undertaken.