Incidence and characteristics of cerebral hypoxia after craniectomy in brain-injured patients: a cohort study.
| Title: | Incidence and characteristics of cerebral hypoxia after craniectomy in brain-injured patients: a cohort study. |
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| Authors: | Gagnon A; 1Nursing School, Université de Montréal.; 2Neurosurgical Department, Université de Montréal.; 3Pharmacy Department, Université de Montréal.; 4Medicine Department, Université de Montréal; and.; 5Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l'Ile-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Québec, Canada.; Laroche M; 2Neurosurgical Department, Université de Montréal.; 3Pharmacy Department, Université de Montréal.; 4Medicine Department, Université de Montréal; and.; 5Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l'Ile-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Québec, Canada.; Williamson D; 3Pharmacy Department, Université de Montréal.; 4Medicine Department, Université de Montréal; and.; 5Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l'Ile-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Québec, Canada.; Giroux M; 2Neurosurgical Department, Université de Montréal.; 3Pharmacy Department, Université de Montréal.; 4Medicine Department, Université de Montréal; and.; 5Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l'Ile-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Québec, Canada.; Giguère JF; 2Neurosurgical Department, Université de Montréal.; 3Pharmacy Department, Université de Montréal.; 4Medicine Department, Université de Montréal; and.; 5Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l'Ile-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Québec, Canada.; Bernard F; 4Medicine Department, Université de Montréal; and.; 5Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l'Ile-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Québec, Canada. |
| Source: | Journal of neurosurgery [J Neurosurg] 2020 Nov 06; Vol. 135 (2), pp. 554-561. Date of Electronic Publication: 2020 Nov 06 (Print Publication: 2021). |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: American Association of Neurological Surgeons Country of Publication: United States NLM ID: 0253357 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1933-0693 (Electronic) Linking ISSN: 00223085 NLM ISO Abbreviation: J Neurosurg Subsets: MEDLINE; PubMed not MEDLINE |
| Imprint Name(s): | Publication: Charlottesville, VA : American Association of Neurological Surgeons; Original Publication: Chicago [etc.] |
| Abstract: | Objective: After craniectomy, although intracranial pressure (ICP) is controlled, episodes of brain hypoxia might still occur. Cerebral hypoxia is an indicator of poor outcome independently of ICP and cerebral perfusion pressure. No study has systematically evaluated the incidence and characteristics of brain hypoxia after craniectomy. The authors' objective was to describe the incidence and characteristics of brain hypoxia after craniectomy.; Methods: The authors included 25 consecutive patients who underwent a craniectomy after traumatic brain injury or intracerebral hemorrhage and who were monitored afterward with a brain tissue oxygen pressure monitor.; Results: The frequency of hypoxic values after surgery was 14.6% despite ICP being controlled. Patients had a mean of 18 ± 23 hypoxic episodes. Endotracheal (ET) secretions (17.4%), low cerebral perfusion pressure (10.3%), and mobilizing the patient (8.6%) were the most common causes identified. Elevated ICP was rarely identified as the cause of hypoxia (4%). No cause of cerebral hypoxia could be determined 31.2% of the time. Effective treatments that were mainly used included sedation/analgesia (20.8%), ET secretion suctioning (15.4%), and increase in fraction of inspired oxygen or positive end-expiratory pressure (14.1%).; Conclusions: Cerebral hypoxia is common after craniectomy, despite ICP being controlled. ET secretion and patient mobilization are common causes that are easily treatable and often not identified by standard monitoring. These results suggest that monitoring should be pursued even if ICP is controlled. The authors' findings might provide a hypothesis to explain the poor functional outcome in the recent randomized controlled trials on craniectomy after traumatic brain injury where in which brain tissue oxygen pressure was not measured. |
| Contributed Indexing: | Keywords: cerebral oxygenation; decompressive craniectomy; disease management; intracranial pressure; multimodality monitoring; traumatic brain injury |
| Entry Date(s): | Date Created: 20201106 Latest Revision: 20240808 |
| Update Code: | 20260130 |
| DOI: | 10.3171/2020.6.JNS20776 |
| PMID: | 33157533 |
| Database: | MEDLINE |
Journal Article