Journal
NEUROSURGERY
Volume 67, Issue 2, Pages 338-344Publisher
OXFORD UNIV PRESS INC
DOI: 10.1227/01.NEU.0000371979.48809.D9
Keywords
Acute lung injury; Brain hypoxia; Brain tissue oxygen tension; Lung function; Systemic oxygenation; Traumatic brain injury
Categories
Funding
- SICPA Foundation, Switzerland
- Integra Foundation
- Integra Neurosciences
- Mary Elisabeth Groff Surgical and Medical Research Trust
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BACKGROUND: Pulmonary complications are frequently observed after severe traumatic brain injury (TBI), but little is known about the consequences of lung injury on brain tissue oxygenation and metabolism. OBJECTIVE: We examined the association between lung function and brain tissue oxygen tension (PbtO(2)) in patients with severe TBI. METHODS: We analyzed data from 78 patients with severe, nonpenetrating TBI who underwent continuous PbtO(2) and intracranial pressure monitoring. Acute lung injury was defined by the presence of pulmonary infiltrates with a PaO2/FiO(2) (PF) ratio less than 300 and the absence of left ventricular failure. A total of 587 simultaneous measurements of PbtO(2) and PF ratio were examined using longitudinal data analysis. RESULTS: PbtO(2) correlated strongly with PaO2 and PF ratio (P < .05) independent of PaCO2, brain temperature, cerebral perfusion pressure, and hemoglobin. Acute lung injury was associated with lower PbtO(2) (34.6 +/- 13.8 mm Hg at PF ratio > 300 vs 30.2 +/- 10.8 mm Hg [ PF ratio 200-300], 28.9 +/- 9.8 mm Hg [ PF ratio 100-199], and 21.1 +/- 7.4 mm Hg [ PF ratio < 100], all P values <. 01). After adjusting for intracranial pressure, Marshall computed tomography score, and APACHE II (Acute Physiology and Chronic Health Evaluation) score, acute lung injury was an independent risk factor for compromised PbtO(2) (PbtO(2) < 20 mm Hg; adjusted odds ratio: 2.13, 95% confidence interval: 1.21-3.77; P < .01). CONCLUSION: After severe TBI, PbtO(2) correlates with PF ratio. Acute lung injury is associated with an increased risk of compromised PbtO(2), independent from intracerebral and systemic injuries. Our findings support the use of lung-protective strategies to prevent brain hypoxia in TBI patients.
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