Abstract：
Traumatic brain injury (TBI) is a major public health burden, causing death and disability worldwide. Intracranial hypertension and brain hypoxia are the main mechanisms of secondary brain injury. As such, management strategies guided by intracranial pressure (ICP) and brain oxygen (PbtO2) monitoring could improve the prognosis of these patients. Our objective was to summarize the current evidence regarding the impact of PbtO2-guided therapy on the outcome of patients with TBI. We performed a systematic search of PubMed, Scopus, and the Cochrane library databases, following the protocol registered in PROSPERO. Only studies comparing PbtO2/ICP-guided therapy with ICP-guided therapy were selected. Primary outcome was neurological outcome at 3 and 6 months assessed by using the Glasgow Outcome Scale; secondary outcomes included hospital and long-term mortality, burden of intracranial hypertension, and brain tissue hypoxia. Out of 6254 retrieved studies, 15 studies (n = 37,245 patients, of who 2184 received PbtO2-guided therapy) were included in the final analysis. When compared with ICP-guided therapy, the use of combined PbO2/ICP-guided therapy was associated with a higher probability of favorable neurological outcome (odds ratio 2.21 [95% confidence interval 1.72-2.84]) and of hospital survival (odds ratio 1.15 [95% confidence interval 1.04-1.28]). The heterogeneity (I2) of the studies in each analysis was below 40%. However, the quality of evidence was overall low to moderate. In this meta-analysis, PbtO2-guided therapy was associated with reduced mortality and more favorable neurological outcome in patients with TBI. The low-quality evidence underlines the need for the results from ongoing phase III randomized trials.
摘要：
创伤性脑损伤(TBI)是主要的公共卫生负担,造成全世界的死亡和残疾。颅内高压和脑缺氧是继发性脑损伤的主要机制。因此，以颅内压（ICP）和脑氧（PbtO2）监测为指导的管理策略可以改善这些患者的预后。我们的目的是总结目前关于PbtO2指导治疗对TBI患者预后影响的证据。我们对PubMed进行了系统搜索,Scopus,和Cochrane图书馆数据库，遵循PROSPERO中注册的协议。仅选择比较PbtO2/ICP引导治疗与ICP引导治疗的研究。主要结局是使用格拉斯哥结局量表评估的3个月和6个月时的神经系统结局；次要结局包括住院和长期死亡率。颅内高压的负担，和脑组织缺氧。在检索到的6254项研究中，15项研究（n=37,245例患者，2184名接受PbtO2指导治疗的患者)被纳入最终分析.与ICP引导治疗相比，PbO2/ICP联合引导治疗的使用与较高的神经系统预后(比值比2.21[95%置信区间1.72~2.84])和住院生存率(比值比1.15[95%置信区间1.04~1.28])的概率相关.每个分析中研究的异质性(I2)低于40%。然而,证据质量总体为低至中度.在这个荟萃分析中，PbtO2指导治疗与TBI患者死亡率降低和神经系统转归更有利相关。低质量的证据强调了对正在进行的III期随机试验结果的需要。
