The Effect of Temperature Increases on Brain Tissue Oxygen Tension in Patients with Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Substudy

Abstract

Fever may aggravate secondary brain injury after traumatic brain injury (TBI). The aim of this study was to identify episodes of temperature increases through visual plot analysis and algorithm supported detection, and to describe associated patterns of changes in on brain tissue oxygen tension (P bt O 2). Data derive from the highresolution cohort of the multicenter prospective Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study. Temperature increases (q0.5°C) were visually identified in 33 patients within the first 11 days of monitoring. Generalized estimating equations were used to detect significant changes of systemic and neuromonitoring parameters from baseline to the highest temperature. Patients were median 50 (interquartile range [IQR], 35-62) years old, and presented with a Glasgow Coma Scale (GCS) of 8 (IQR, 4-10). In 202 episodes of temperature increases, mean temperature rose by 1.0°C-0.5°C within 4 hours. Overall, P bt O 2 slightly increased (DP bt O 2 = 0.9-6.1 mmHg, p = 0.022) during temperature increases. P bt O 2 increased in 35% (p < 0.001), was stable in 49% (p = 0.852), and decreased in 16% (p < 0.001) of episodes. During episodes of temperature increases and simultaneous drops in P bt O 2 , cerebral perfusion pressure (CPP) decreased (DCPP-6.3-11.5 mmHg; p < 0.001). Brain tissue hypoxia (P bt O 2 <20 mmHg) developed during 27/164 (17%) episodes of effervescences, in the remaining 38/202 episodes baseline P bt O 2 was already <20 mmHg. Comparable results were found when using algorithm-supported detection of temperature increases. In conclusion, during effervescences, P bt O 2 was mostly stable or slightly increased. A decrease of P bt O 2 was observed in every sixth episode, where it was associated with a decrease in CPP. Our data highlight the need for special attention to CPP monitoring and maintenance during episodes of fever.

Cerebral Oxygen Delivery and Consumption in Brain-Injured Patients

“…PbtO 2 may rise on average in every third and decrease in every sixth episode of high temperature. Recent data have documented that the PbtO 2 slope may occur simultaneously with CPP and MAP reduction [156].…”