Elisabete Monteiro1, António Ferreira2, Edite Mendes2, Cláudia Camila Dias3, Marek Czosnyka4, José Artur Paiva2, Celeste Dias2. 1. Department of Intensive Care Medicine, Centro Hospitalar e Universitário São João, Porto, Portugal. elisabetemargaridasofia@gmail.com. 2. Department of Intensive Care Medicine, Centro Hospitalar e Universitário São João, Porto, Portugal. 3. Faculdade de Medicina da Universidade do Porto MEDCIDS-Departamento de Medicina da Comunidade, Informação e Decisão em Saúde e CINTESIS-Centro de Investigação em Tecnologias e em Serviços de Saúde, Porto, Portugal. 4. Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Abstract
INTRODUCTION: Advanced multimodal monitoring (MMM) of the brain is recommended as a tool to manage severe acute brain injury in intensive care units (ICUs) and prevent secondary lesions. The aim of this study was to determine if MMM has implications for patient outcome and mortality. METHODS: We analyzed data on 389 patients admitted with a subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI) to two general ICUs and one neurocritical care ICU (NCCU) between March 2014 and October 2016, and their subsequent outcomes. RESULTS: The study population consisted of 259 males and 130 females. Group 1, which comprised 69 patients with MMM admitted to the NCCU, was compared with group 2, which comprised patients managed without MMM. With the exceptions of the Simplified Acute Physiology Score (SAPS II) and Glasgow Coma Scale (GCS) scores, there were no differences between the two groups. Group 1 had significantly better outcomes at ICU discharge, at 28 days, and at 3 months, and also had a lower mortality rate (P < 0.05). When outcomes were adjusted for SAPS II scores, patients who had MMM had better outcomes (odds ratios 0.215 at ICU discharge, 0.234 at 28 days, 0.338 at 3 months, and 0.474 at 6 months) but no difference in mortality. CONCLUSION: Use of MMM in patients with SAH or TBI is associated with better outcomes and should be considered in the management of these patients.
INTRODUCTION: Advanced multimodal monitoring (MMM) of the brain is recommended as a tool to manage severe acute brain injury in intensive care units (ICUs) and prevent secondary lesions. The aim of this study was to determine if MMM has implications for patient outcome and mortality. METHODS: We analyzed data on 389 patients admitted with a subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI) to two general ICUs and one neurocritical care ICU (NCCU) between March 2014 and October 2016, and their subsequent outcomes. RESULTS: The study population consisted of 259 males and 130 females. Group 1, which comprised 69 patients with MMM admitted to the NCCU, was compared with group 2, which comprised patients managed without MMM. With the exceptions of the Simplified Acute Physiology Score (SAPS II) and Glasgow Coma Scale (GCS) scores, there were no differences between the two groups. Group 1 had significantly better outcomes at ICU discharge, at 28 days, and at 3 months, and also had a lower mortality rate (P < 0.05). When outcomes were adjusted for SAPS II scores, patients who had MMM had better outcomes (odds ratios 0.215 at ICU discharge, 0.234 at 28 days, 0.338 at 3 months, and 0.474 at 6 months) but no difference in mortality. CONCLUSION: Use of MMM in patients with SAH or TBI is associated with better outcomes and should be considered in the management of these patients.
Authors: Marcel J H Aries; Marek Czosnyka; Karol P Budohoski; Luzius A Steiner; Andrea Lavinio; Angelos G Kolias; Peter J Hutchinson; Ken M Brady; David K Menon; John D Pickard; Peter Smielewski Journal: Crit Care Med Date: 2012-08 Impact factor: 7.598