Multimodal brain monitoring in the management of patients with severe traumatic brain injury

Abstract

Overview of the topic: The implementation of multimodal brain monitoring which would allow to obtain multiple values on a timely basis is believed to be a step forward individualized management of the patients with severe TBIs. In this dissertation, the review will be made regarding the combination of PbtO2 and ICP monitoring and its efficacy in improving patient functional outcome. The research question: In critical care of adult patients with severe traumatic brain injury, would PbtO2 monitoring in conjunction with conventional ICP/CPP monitoring result in improved functional outcome compare to ICP/CPP monitoring alone? PICO elements: The population (P) studied was adult patients with severe TBI. The intervention (I) was PbtO2 monitoring in conjunction with ICP/CPP monitoring. The comparison intervention (C) was ICP/CPP monitoring. The desired outcome (O) was improvement of functional outcome. Method: The key terms of the PICO question were used to explore PubMed and EBSCO databases. Only those studies which were published in the last ten years and compared patient functional outcome between the groups exposed to PbtO2/ICP monitoring and ICP monitoring were eligible for inclusion. Another inclusion criterion was adult patients with severe TBI and GCS < 9. Nine studies were retrieved. Each study was critically appraised employing Critical Appraisal Skills Programme (CASP) tools. Results: Findings obtained from the key studies were highly inconsistent and most of the studies could not reach statistically significant results. Conclusion: A definite conclusion could not be reached, however, the strong association was observed between monitoring modality and improved functional outcome in patients who have undergone cerebral oxygen monitoring. Implications and recommendations: PbtO2 monitoring cannot be integrated in the routine management of severe TBI patients due to the absence of robust evidence considering its efficacy. There is a substantial need for further clinical studies with more robust methodological base.