180 The Impact of Brain Tissue Oxygen Monitoring With Intracranial Pressure Monitoring on Patients With Severe TBI: A National Trauma Bank Data Analysis

Abstract

INTRODUCTION: While numerous studies have demonstrated the importance of ICP monitoring in improving the mortality rate for severe traumatic brain injuries (TBI), the benefits of brain oxygenation monitoring (PbO2) in combination with ICP monitoring are still currently under investigation as part of the BOOST III trial. METHODS: Patients with severe TBI based on the Glascow Coma Scale were identified using National Trauma Bank data from 2019-2021. Patients who died in the ED, had ED disposition inconsistent with severe TBI, or were transferred to another hospital were excluded. Summary statistics, t-tests, chi-square tests, non-parametric tests, multivariate logistic models, and log-log regression models were used to evaluate and model the data. RESULTS: 13,139 patients with severe TBI who underwent ICP monitoring were identified, with 709 (5%) undergoing PbO2 monitoring. Patients with PbO2 monitors had longer ICU length of stay (17.3 days vs. 14.3 days p < .05) and a longer duration of ventilation (14.5 days vs. 12 days p < .05). Additionally, patients with PbO2 monitors experienced increased rates of deep vein thrombosis and pulmonary embolism (OR 1.57 95% CI; 1.22-2.01). There was no significant difference in mortality rate with PbO2 monitoring after controlling for severity (4.5% vs. 4%, p = 0.07). CONCLUSIONS: PbO2 monitoring was associated with longer ICU length of stay and days ventilated, consistent with prior studies. Patients with PbO2 monitoring experienced higher rates of deep vein thrombosis and pulmonary embolism. Different from previous studies, our results indicate PbO2 monitoring does not impact mortality outcomes. Data about functional outcomes are not yet available. Further studies are needed to address this discrepancy; the ongoing BOOST III trial may provide a better understanding on the proper use of PbO2 monitoring.