Advanced neuromonitoring including cerebral tissue oxygenation and outcomeafter traumatic brain injury

For 51 patients suffering from traumatic brain injury (GCS < 9), we compare d the prognostic value of critical parameters derived from neuromonitoring of intracranial pressure (ICP) cerebral perfusion pressure (CPP) and brain tissue oxygenation (PtiO2) during different time periods after trauma (less than or equal to 12, less than or equal to 24, less than or equal to 48, l ess than or equal to 72 and less than or equal to 96 h). For patients with good outcome (GOS = 4-5, n = 30) the proportion of critical ICP values (> 4 0 mmHg) was about 0.2% during all time periods. The corresponding proportio ns for patients with bad outcome (GOS = 1-3, n = 21) rose from 0.2% to 4.7% during increasing time periods. The frequency of critical ICP values was s ignificantly related to outcome (p < 0.001) for time periods > 48 h after t rauma. Differences of critical CPP (less than or equal to 50 mmHg) and hypo xic PtiO2 (less than or equal to 5 mmHg) between both outcome groups were l ess pronounced and for both parameters significant relations to outcome wer e only obtained for the longest time period (less than or equal to 96 h, p less than or equal to 0.05). Higher thresholds for CPP (less than or equal to 60 mmHg, less than or equal to 70 mmHg) did not reveal any relation to o utcome. For all neuromonitoring parameters significant relations between th e frequency of critical values and outcome could be determined. Critical IC P values provide the earliest and highest prognostic power, while critical CPP and hypoxic PtiO2 only showed prognostic power in later time periods.