Patient transport and brain oxygen in comatose patients

Edward W. Swanson, Justin R Mascitelli, Michael Stiefel, Eileen MacMurtrie, Joshua Levine, W. Andrew Kofke, Wei Yang, Peter D. Le Roux

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

OBJECTIVE: Transport of critically ill intensive care unit patients may be hazardous. We examined whether brain oxygen (brain tissue oxygen partial pressure [PbtO2]) is influenced by transport to and from a follow-up head computed tomography (transport head computed tomography [tHCT]) scan. METHODS: Forty-five patients (24 men, 21 women; Glasgow Coma Scale score ≤8; mean age, 47.3 ± 19.0 years) who had a traumatic brain injury (n = 26) or subarachnoid hemorrhage (n = 19) were retrospectively identified from a prospective observational cohort of PbtO2 monitoring in a neurosurgical intensive care unit at a university-based level I trauma center. PbtO2, intracranial pressure, and cerebral perfusion pressure were monitored continuously and compared during the 3 hours before and after 100 tHCT scans. RESULTS: The mean PbtO2 before and after the tHCT scans for all 100 scans was 37.9 ± 19.8 mm Hg and 33.9 ± 17.2 mm Hg, respectively (P = .0001). A decrease in PbtO2 (>5%) occurred after 54 tHCTs (54%) and in 36 patients (80%). In instances in which a decrease occurred, the average decrease in mean, minimum, and maximum PbtO2 was 23.6%, 29%, and 18.1%, respectively. This decrease was greater when PbtO2 was compromised (<25 mm Hg) before tHCT. An episode of brain hypoxia (<15 mm Hg) was identified in the 3 hours before tHCT in 9 and after tHCT in 19 instances. On average, an episode of brain hypoxia was 46.6 ± 16.0 (standard error) minutes longer after tHCT than before tHCT (P = .008). Multivariate analysis suggests that changes in lung function (PaO 2/fraction of inspired oxygen [FiO2] ratio) may account for the reduced PbtO2 after tHCT (parameter estimate 0.45, 95% confidence interval: 0.024-0.871; P = .04). CONCLUSION: These data suggest that transport to and from the intensive care unit may adversely affect PbtO 2. This deleterious effect is greater when PbtO2 is already compromised and may be associated with lung function.

Original languageEnglish (US)
Pages (from-to)925-931
Number of pages7
JournalNeurosurgery
Volume66
Issue number5
DOIs
StatePublished - May 1 2010
Externally publishedYes

Fingerprint

Coma
Head
Tomography
Oxygen
Brain
Intensive Care Units
Brain Hypoxia
Cerebrovascular Circulation
Lung
Glasgow Coma Scale
Partial Pressure
Trauma Centers
Intracranial Pressure
Subarachnoid Hemorrhage
Critical Illness
Multivariate Analysis
Confidence Intervals

Keywords

  • Brain oxygen
  • Computed tomography
  • Intracranial pressure
  • Subarachnoid hemorrhage
  • Transport
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Swanson, E. W., Mascitelli, J. R., Stiefel, M., MacMurtrie, E., Levine, J., Kofke, W. A., ... Le Roux, P. D. (2010). Patient transport and brain oxygen in comatose patients. Neurosurgery, 66(5), 925-931. https://doi.org/10.1227/01.NEU.0000368543.59446.A4

Patient transport and brain oxygen in comatose patients. / Swanson, Edward W.; Mascitelli, Justin R; Stiefel, Michael; MacMurtrie, Eileen; Levine, Joshua; Kofke, W. Andrew; Yang, Wei; Le Roux, Peter D.

In: Neurosurgery, Vol. 66, No. 5, 01.05.2010, p. 925-931.

Research output: Contribution to journalArticle

Swanson, EW, Mascitelli, JR, Stiefel, M, MacMurtrie, E, Levine, J, Kofke, WA, Yang, W & Le Roux, PD 2010, 'Patient transport and brain oxygen in comatose patients', Neurosurgery, vol. 66, no. 5, pp. 925-931. https://doi.org/10.1227/01.NEU.0000368543.59446.A4
Swanson EW, Mascitelli JR, Stiefel M, MacMurtrie E, Levine J, Kofke WA et al. Patient transport and brain oxygen in comatose patients. Neurosurgery. 2010 May 1;66(5):925-931. https://doi.org/10.1227/01.NEU.0000368543.59446.A4
Swanson, Edward W. ; Mascitelli, Justin R ; Stiefel, Michael ; MacMurtrie, Eileen ; Levine, Joshua ; Kofke, W. Andrew ; Yang, Wei ; Le Roux, Peter D. / Patient transport and brain oxygen in comatose patients. In: Neurosurgery. 2010 ; Vol. 66, No. 5. pp. 925-931.
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AU - Yang, Wei

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N2 - OBJECTIVE: Transport of critically ill intensive care unit patients may be hazardous. We examined whether brain oxygen (brain tissue oxygen partial pressure [PbtO2]) is influenced by transport to and from a follow-up head computed tomography (transport head computed tomography [tHCT]) scan. METHODS: Forty-five patients (24 men, 21 women; Glasgow Coma Scale score ≤8; mean age, 47.3 ± 19.0 years) who had a traumatic brain injury (n = 26) or subarachnoid hemorrhage (n = 19) were retrospectively identified from a prospective observational cohort of PbtO2 monitoring in a neurosurgical intensive care unit at a university-based level I trauma center. PbtO2, intracranial pressure, and cerebral perfusion pressure were monitored continuously and compared during the 3 hours before and after 100 tHCT scans. RESULTS: The mean PbtO2 before and after the tHCT scans for all 100 scans was 37.9 ± 19.8 mm Hg and 33.9 ± 17.2 mm Hg, respectively (P = .0001). A decrease in PbtO2 (>5%) occurred after 54 tHCTs (54%) and in 36 patients (80%). In instances in which a decrease occurred, the average decrease in mean, minimum, and maximum PbtO2 was 23.6%, 29%, and 18.1%, respectively. This decrease was greater when PbtO2 was compromised (<25 mm Hg) before tHCT. An episode of brain hypoxia (<15 mm Hg) was identified in the 3 hours before tHCT in 9 and after tHCT in 19 instances. On average, an episode of brain hypoxia was 46.6 ± 16.0 (standard error) minutes longer after tHCT than before tHCT (P = .008). Multivariate analysis suggests that changes in lung function (PaO 2/fraction of inspired oxygen [FiO2] ratio) may account for the reduced PbtO2 after tHCT (parameter estimate 0.45, 95% confidence interval: 0.024-0.871; P = .04). CONCLUSION: These data suggest that transport to and from the intensive care unit may adversely affect PbtO 2. This deleterious effect is greater when PbtO2 is already compromised and may be associated with lung function.

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