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Anemia and brain oxygen after severe traumatic brain injury
- Source :
- Intensive Care Medicine. 38:1497-1504
- Publication Year :
- 2012
- Publisher :
- Springer Science and Business Media LLC, 2012.
-
Abstract
- To investigate the relationship between hemoglobin (Hgb) and brain tissue oxygen tension (PbtO(2)) after severe traumatic brain injury (TBI) and to examine its impact on outcome.This was a retrospective analysis of a prospective cohort of severe TBI patients whose PbtO(2) was monitored. The relationship between Hgb-categorized into four quartiles (≤9; 9-10; 10.1-11;11 g/dl)-and PbtO(2) was analyzed using mixed-effects models. Anemia with compromised PbtO(2) was defined as episodes of Hgb ≤ 9 g/dl with simultaneous PbtO(2)20 mmHg. Outcome was assessed at 30 days using the Glasgow outcome score (GOS), dichotomized as favorable (GOS 4-5) vs. unfavorable (GOS 1-3).We analyzed 474 simultaneous Hgb and PbtO(2) samples from 80 patients (mean age 44 ± 20 years, median GCS 4 (3-7)). Using Hgb11 g/dl as the reference level, and controlling for important physiologic covariates (CPP, PaO(2), PaCO(2)), Hgb ≤ 9 g/dl was the only Hgb level that was associated with lower PbtO(2) (coefficient -6.53 (95 % CI -9.13; -3.94), p0.001). Anemia with simultaneous PbtO(2)20 mmHg, but not anemia alone, increased the risk of unfavorable outcome (odds ratio 6.24 (95 % CI 1.61; 24.22), p = 0.008), controlling for age, GCS, Marshall CT grade, and APACHE II score.In this cohort of severe TBI patients whose PbtO(2) was monitored, a Hgb level no greater than 9 g/dl was associated with compromised PbtO(2). Anemia with simultaneous compromised PbtO(2), but not anemia alone, was a risk factor for unfavorable outcome, irrespective of injury severity.
- Subjects :
- Adult
Male
medicine.medical_specialty
Anemia
Traumatic brain injury
chemistry.chemical_element
macromolecular substances
Brain tissue
Critical Care and Intensive Care Medicine
Oxygen
Hemoglobins
Risk Factors
hemic and lymphatic diseases
Anesthesiology
Confidence Intervals
medicine
Humans
Glasgow Coma Scale
APACHE
Retrospective Studies
business.industry
Brain
medicine.disease
Oxygen tension
nervous system
chemistry
Brain Injuries
Anesthesia
Female
Hemoglobin
business
Subjects
Details
- ISSN :
- 14321238 and 03424642
- Volume :
- 38
- Database :
- OpenAIRE
- Journal :
- Intensive Care Medicine
- Accession number :
- edsair.doi.dedup.....4ba1b08e9a5018afda950ab156e73798