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Prognostic value of near-infrared spectroscopy regional oxygen saturation and cerebrovascular reactivity index in acute traumatic neural injury: a CAnadian High-Resolution Traumatic Brain Injury (CAHR-TBI) Cohort Study.

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Peer-reviewed

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Abstract

BACKGROUND: Near-infrared spectroscopy regional cerebral oxygen saturation (rSO2) has gained interest as a raw parameter and as a basis for measuring cerebrovascular reactivity (CVR) due to its noninvasive nature and high spatial resolution. However, the prognostic utility of these parameters has not yet been determined. This study aimed to identify threshold values of rSO2 and rSO2-based CVR at which outcomes worsened following traumatic brain injury (TBI). METHODS: A retrospective multi-institutional cohort study was performed. The cohort included TBI patients treated in four adult intensive care units (ICU). The cerebral oxygen indices, COx (using rSO2 and cerebral perfusion pressure) as well as COx_a (using rSO2 and arterial blood pressure) were calculated for each patient. Grand mean thresholds along with exposure-based thresholds were determined utilizing sequential chi-squared analysis and univariate logistic regression, respectively. RESULTS: In the cohort of 129 patients, there was no identifiable threshold for raw rSO2 at which outcomes were found to worsen. For both COx and COx_a, an optimal grand mean threshold value of 0.2 was identified for both survival and favorable outcomes, while percent time above - 0.05 was uniformly found to have the best discriminative value. CONCLUSIONS: In this multi-institutional cohort study, raw rSO2was found to contain no significant prognostic information. However, rSO2-based indices of CVR, COx and COx_a, were found to have a uniform grand mean threshold of 0.2 and exposure-based threshold of - 0.05, above which clinical outcomes markedly worsened. This study lays the groundwork to transition to less invasive means of continuously measuring CVR.

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Acknowledgements: We would like to acknowledge the patients and staff of the Foothills Medical Centre, Health Sciences Centre Winnipeg, Maastricht University Medical Center and the Vancouver General Hospital, without which the data from this study would not be possible.


Funder: Canadian Institutes of Health Research; doi: http://dx.doi.org/10.13039/501100000024


Funder: Natural Sciences and Engineering Research Council of Canada; doi: http://dx.doi.org/10.13039/501100000038


Funder: Research Manitoba; doi: http://dx.doi.org/10.13039/100008794


Funder: The Brain Canada Thompkins Travel Scholarship


Funder: The Graduate Enhancement of Tri-Council Stipends (GETS) – University of Manitoba


Funder: Karolinska Institutet Funds


Funder: The Swedish Brain Foundation


Funder: The Swedish Society of Medicine


Funder: Region Stockholm ALF


Funder: Region Stockholm Clinical Research Appointment


Funder: The Swedish Cultural Foundation in Finland


Funder: Finska Läkaresällskapet; doi: http://dx.doi.org/10.13039/100010135


Funder: Helsinki university hospital state funded research grant


Funder: University of Manitoba R.G. and E.M. Graduate Fellowship (Doctoral) in Biomedical Engineering


Funder: University of Manitoba MD/PhD program


Funder: University of Manitoba Endowed Manitoba Public Insurance (MPI) Chair in Neuroscience/TBI Research Endowment


Funder: The MPI Neuroscience Research Operating Fund


Funder: The Health Sciences Centre Foundation Winnipeg


Funder: Canada Foundation for Innovation; doi: http://dx.doi.org/10.13039/501100000196


Funder: University of Manitoba VPRI Research Investment Fund

Keywords

Cerebrovascular reactivity, Multimodal monitoring, Near-infrared spectroscopy, Traumatic brain injury, Adult, Humans, Cohort Studies, Prognosis, Retrospective Studies, Spectroscopy, Near-Infrared, Oxygen Saturation, Canada, Brain Injuries, Traumatic

Journal Title

Crit Care

Conference Name

Journal ISSN

1364-8535
1466-609X

Volume Title

28

Publisher

Springer Science and Business Media LLC