Targeted temperature management and PbtO2 in traumatic brain injury

Introduction: Targeted Temperature Management (TTM) to normothermia is widely used in traumatic brain injury (TBI). We investigated the effects to of TTM to normothermia patients with TBI (GCS≤12) monitored with multimodality monitoring, to better understand the physiological consequences of this in...

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Main Authors: Nika Cujkevic-Plecko, A. Rodriguez, T. Anderson, J. Rhodes
Format: Article
Language:English
Published: Elsevier 2023-01-01
Series:Brain and Spine
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S277252942300992X
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author Nika Cujkevic-Plecko
A. Rodriguez
T. Anderson
J. Rhodes
author_facet Nika Cujkevic-Plecko
A. Rodriguez
T. Anderson
J. Rhodes
author_sort Nika Cujkevic-Plecko
collection DOAJ
description Introduction: Targeted Temperature Management (TTM) to normothermia is widely used in traumatic brain injury (TBI). We investigated the effects to of TTM to normothermia patients with TBI (GCS≤12) monitored with multimodality monitoring, to better understand the physiological consequences of this intervention. Research question: In TBI patients cooled to normothermia and in which brain oxygenation deteriorates, are there changes in physiological parameters which are pertinent to brain oxygenation? Material and method: 102 TBI patients with continuous recordings of intracranial pressure (ICP) and brain oxygen tension (PbtO2) were studied retrospectively. Non-continuous arterial carbon dioxide (PaCO2) and oxygen (PaO2) tensions, and core body temperature (Tc) were added. PaO2 and PaCO2 were also corrected for Tc. Transitions from elevated Tc to normothermia were identified in 39 patients. The 8 h pre and post the transition to normothermia were compared. Data is given as median [IQR] or mean (SD). Results: Overall, normothermia reduced ICP (12 [9–18] −11 [8–17] mmHg, p < 0.009) and Tcore (38.3 [0.3]-36.9 [0.4] oC, p < 0.001), but not PbtO2 (23.3 [16.6]-24.4 [17.2–28.7] mmHg, NS). Normothermia was associated with a fall in PbtO2 in 18 patients (24.5 [9.3] −20.8 [7.6] mmHg). Only in those with a fall in PbtO2 with cooling did ICP (15 [10.8–18.5] −12 [7.8–17.3] mmHg, p = 0.002), and temperature corrected PaCO2 (5.3 [0.5]- 4.9 [0.8] kPa, p = 0.001) decrease. Discussion and conclusion: A reduction in PbtO2 was only present in the subgroup of patients with a fall in temperature corrected PaCO2 with cooling. This suggests that even modest temperature changes could result in occult hyperventilation in some patients. pH stat correction of ventilation may be an important factor to consider in future TTM protocols.
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spelling doaj.art-ece105c53c5444558cfaf672ce7098762023-12-09T06:09:18ZengElsevierBrain and Spine2772-52942023-01-013102704Targeted temperature management and PbtO2 in traumatic brain injuryNika Cujkevic-Plecko0A. Rodriguez1T. Anderson2J. Rhodes3University of Edinburgh Medical School, UKUsher Institute, University of Edinburgh, UKUniversity of Edinburgh Department of Anaesthesia, Critical Care and Pain Medicine &amp; NHS Lothian, UKUniversity of Edinburgh Department of Anaesthesia, Critical Care and Pain Medicine &amp; NHS Lothian, UK; Corresponding author. University of Edinburgh Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UKIntroduction: Targeted Temperature Management (TTM) to normothermia is widely used in traumatic brain injury (TBI). We investigated the effects to of TTM to normothermia patients with TBI (GCS≤12) monitored with multimodality monitoring, to better understand the physiological consequences of this intervention. Research question: In TBI patients cooled to normothermia and in which brain oxygenation deteriorates, are there changes in physiological parameters which are pertinent to brain oxygenation? Material and method: 102 TBI patients with continuous recordings of intracranial pressure (ICP) and brain oxygen tension (PbtO2) were studied retrospectively. Non-continuous arterial carbon dioxide (PaCO2) and oxygen (PaO2) tensions, and core body temperature (Tc) were added. PaO2 and PaCO2 were also corrected for Tc. Transitions from elevated Tc to normothermia were identified in 39 patients. The 8 h pre and post the transition to normothermia were compared. Data is given as median [IQR] or mean (SD). Results: Overall, normothermia reduced ICP (12 [9–18] −11 [8–17] mmHg, p < 0.009) and Tcore (38.3 [0.3]-36.9 [0.4] oC, p < 0.001), but not PbtO2 (23.3 [16.6]-24.4 [17.2–28.7] mmHg, NS). Normothermia was associated with a fall in PbtO2 in 18 patients (24.5 [9.3] −20.8 [7.6] mmHg). Only in those with a fall in PbtO2 with cooling did ICP (15 [10.8–18.5] −12 [7.8–17.3] mmHg, p = 0.002), and temperature corrected PaCO2 (5.3 [0.5]- 4.9 [0.8] kPa, p = 0.001) decrease. Discussion and conclusion: A reduction in PbtO2 was only present in the subgroup of patients with a fall in temperature corrected PaCO2 with cooling. This suggests that even modest temperature changes could result in occult hyperventilation in some patients. pH stat correction of ventilation may be an important factor to consider in future TTM protocols.http://www.sciencedirect.com/science/article/pii/S277252942300992XTargeted temperature managementTraumatic brain injuryMulti-modality monitoringCerebral haemodynamics
spellingShingle Nika Cujkevic-Plecko
A. Rodriguez
T. Anderson
J. Rhodes
Targeted temperature management and PbtO2 in traumatic brain injury
Brain and Spine
Targeted temperature management
Traumatic brain injury
Multi-modality monitoring
Cerebral haemodynamics
title Targeted temperature management and PbtO2 in traumatic brain injury
title_full Targeted temperature management and PbtO2 in traumatic brain injury
title_fullStr Targeted temperature management and PbtO2 in traumatic brain injury
title_full_unstemmed Targeted temperature management and PbtO2 in traumatic brain injury
title_short Targeted temperature management and PbtO2 in traumatic brain injury
title_sort targeted temperature management and pbto2 in traumatic brain injury
topic Targeted temperature management
Traumatic brain injury
Multi-modality monitoring
Cerebral haemodynamics
url http://www.sciencedirect.com/science/article/pii/S277252942300992X
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