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The Effect of Temperature Increases on Brain Tissue Oxygen Tension in Patients with Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Substudy
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2021 (Engelska)Ingår i: Therapeutic Hypothermia and Temperature Management, ISSN 2153-7658, E-ISSN 2153-7933, Vol. 11, nr 2, s. 122-131Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Fever may aggravate secondary brain injury after traumatic brain injury (TBI). The aim of this study was to identify episodes of temperature increases through visual plot analysis and algorithm supported detection, and to describe associated patterns of changes in on brain tissue oxygen tension (PbtO2). Data derive from the high-resolution cohort of the multicenter prospective Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study. Temperature increases (≥0.5°C) were visually identified in 33 patients within the first 11 days of monitoring. Generalized estimating equations were used to detect significant changes of systemic and neuromonitoring parameters from baseline to the highest temperature. Patients were median 50 (interquartile range [IQR], 35–62) years old, and presented with a Glasgow Coma Scale (GCS) of 8 (IQR, 4–10). In 202 episodes of temperature increases, mean temperature rose by 1.0°C ± 0.5°C within 4 hours. Overall, PbtO2 slightly increased (ΔPbtO2 = 0.9 ± 6.1 mmHg, p = 0.022) during temperature increases. PbtO2 increased in 35% (p < 0.001), was stable in 49% (p = 0.852), and decreased in 16% (p < 0.001) of episodes. During episodes of temperature increases and simultaneous drops in PbtO2, cerebral perfusion pressure (CPP) decreased (ΔCPP −6.3 ± 11.5 mmHg; p < 0.001). Brain tissue hypoxia (PbtO2 <20 mmHg) developed during 27/164 (17%) episodes of effervescences, in the remaining 38/202 episodes baseline PbtO2 was already <20 mmHg. Comparable results were found when using algorithm-supported detection of temperature increases. In conclusion, during effervescences, PbtO2 was mostly stable or slightly increased. A decrease of PbtO2 was observed in every sixth episode, where it was associated with a decrease in CPP. Our data highlight the need for special attention to CPP monitoring and maintenance during episodes of fever.

Ort, förlag, år, upplaga, sidor
Mary Ann Liebert, 2021. Vol. 11, nr 2, s. 122-131
Nyckelord [en]
traumatic brain injury, temperature increases, brain tissue oxygen tension, critical care, CENTER-TBI
Nationell ämneskategori
Neurologi Neurovetenskaper
Identifikatorer
URN: urn:nbn:se:umu:diva-180055DOI: 10.1089/ther.2020.0027ISI: 000592661000001PubMedID: 33202157Scopus ID: 2-s2.0-85107801430OAI: oai:DiVA.org:umu-180055DiVA, id: diva2:1528690
Tillgänglig från: 2021-02-16 Skapad: 2021-02-16 Senast uppdaterad: 2022-01-12Bibliografiskt granskad

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Koskinen, Lars-Owe D.

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Therapeutic Hypothermia and Temperature Management
NeurologiNeurovetenskaper

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