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KMID : 1201420210140010036
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Journal of Neurocritical Care
2021 Volume.14 No. 1 p.36 ~ p.45
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Treatment of patients with severe traumatic brain injury: a 7-year single institution experience
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Marini Corrado P.
Petrone Patrizio
McNelis John
Lewis Erin
Liveris Anna
Stiefel Michael F.
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Abstract
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Background: This study was designed to compare the efficacy of multimodality monitoring and goal-directed therapy protocol (MM&GDTP), in patients with Glasgow Coma Scale (GCS) scores ≤8 with the conventional intracranial pressure (ICP)-cerebral perfusion pressure (CPP) treatment.
Methods: The study was divided into two time periods, a 2-year historic period in which severe traumatic brain injury (sTBI) patients were treated with an ICP-CPP targeted strategy and a 5-year intervention period during which MM&GDTP was utilized. Patients with unsurvivable brain injuries were excluded. Variables of interest included mechanism of injury, age, sex, hemodynamics, GCS score, abbreviated injury score?head (AIS-H), Marshall Class, injury severity score, decompressive craniectomy, ventilator/intensive care unit days, length of stay, predicted mortality by corticosteroid randomization after significant head injury model, functional outcome, and mortality.
Results: The study group comprised 810 sTBI patients, aged 14?93 years, admitted during a 7-year period; of these patients, 67 and 99 AIS-H≥4 and Marshall Class ≥III were included in control and intervention groups, respectively. The control group was treated with an ICP-CPP targeted approach, while the intervention group with an MM&GDTP. At presentation and after resuscitation, patients in the intervention group required a higher CPP to reach the endpoints of therapy. The MM&GDTP decreased mortality from 34.3% to 23.2%, yielding a 32.3% improvement in overall survival and improved functional outcome as measured by GOS >3 (MM&GDTP vs. ICP-CPP: 50/99 vs. 15/67, P=0.003).
Conclusion: Institution of MM&GDTP targeted to threshold-defined values improves functional outcomes and may reduce mortality among patients with sTBI compared to that of patients receiving an ICP-CPP?based treatment.
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KEYWORD
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Traumatic brain injuries, Severe, Treatment, Multimodality monitoring and goal-directed therapy protocol, Mortality
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