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Brain tissue oxygen combined with intracranial pressure monitoring versus isolated intracranial pressure monitoring in patients with traumatic brain injury: an updated systematic review and meta-analysis

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Abstract

Monitoring intracranial pressure (ICP) is pivotal in the management of severe traumatic brain injury (TBI), but secondary brain injuries can arise despite normal ICP levels. Cerebral tissue oxygenation monitoring (PbtO2) may detect neuronal tissue infarction thresholds, enhancing neuroprotection. We performed a systematic review and meta-analysis to evaluate the effects of combined cerebral tissue oxygenation (PbtO2) and ICP compared to isolated ICP monitoring in patients with TBI. PubMed, Embase, Cochrane, and Web of Sciences databases were searched for trials published up to June 2023. A total of 16 studies comprising 37,820 patients were included. ICP monitoring was universal, with additional placement of PbtO2 in 2222 individuals (5.8%). The meta-analysis revealed a reduction in mortality (OR 0.57, 95% CI 0.37–0.89, p = 0.01), a greater likelihood of favorable outcomes (OR 2.28, 95% CI 1.66–3.14, p < 0.01), and a lower chance of poor outcomes (OR 0.51, 95% CI 0.34–0.79, p < 0.01) at 6 months for the PbtO2 plus ICP group. However, these patients experienced a longer length of hospital stay (MD 2.35, 95% CI 0.50–4.20, p = 0.01). No significant difference was found in hospital mortality rates (OR 0.81, 95% CI 0.61–1.08, p = 0.16) or intensive care unit length of stay (MD 2.46, 95% CI − 0.11–5.04, p = 0.06). The integration of PbtO2 to ICP monitoring improved mortality outcomes and functional recovery at 6 months in patients with TBI. PROSPERO (International Prospective Register of Systematic Reviews) CRD42022383937; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=383937

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Authors and Affiliations

  1. Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Laís Silva Santana

  2. Instituto de Neurologia de Goiânia, Goiânia, Brazil

    Jordana Borges Camargo Diniz

  3. Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo, SP, 05403-010, Brazil

    Davi Jorge Fontoura Solla, Iuri Santana Neville & Eberval Gadelha Figueiredo

  4. Department of Neurology, University of São Paulo, Av Dr Arnaldo, 455 - Cerqueira César, São Paulo, SP, 01246-903, Brazil

    João Paulo Mota Telles

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Santana, L.S., Diniz, J.B.C., Solla, D.J.F. et al. Brain tissue oxygen combined with intracranial pressure monitoring versus isolated intracranial pressure monitoring in patients with traumatic brain injury: an updated systematic review and meta-analysis. Neurol Sci (2024). https://doi.org/10.1007/s10072-024-07392-0

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