PDF(Pubmed)
Abstract：
UNASSIGNED: Partial pressure of brain tissue oxygen (PbtO2) has been shown to be a safe an effective monitoring modality to compliment intracranial pressure (ICP) monitoring. It is related to metabolic activity, disease severity and mortality.
UNASSIGNED: Understanding the complex relationship between PbtO2 and ICP for patients with traumatic brain injury will enable better clinical decision making beyond simple threshold treatment strategies.
UNASSIGNED: Patients with PbtO2 monitoring were identified from the BrainIT database, a multi-centre dataset, containing minute by minute PbtO2 and ICP readings. Missing data was imputed and a multi-level log-normal regression model with a compound symmetry correlation structure was built. This accounted for any increased correlation due to the repeated measurements. The model was adjusted for mean arterial pressure and the partial pressure of carbon dioxide. Non-linearity was assessed using analysis of deviance and trends using expected marginal means.
UNASSIGNED: 11 subjects with over 82,000 readings were included. They had a median age of 38 (IQR: 37-47), 73% were male, a median length of stay of 11.8 (IQR: 6.6-19.7) days and a median extended Glasgow outcome scale of 7.00 (IQR: 5-8).There is a statistically significant (p < 0.001) non-linear effect of ICP on PbtO2. With an overall increase in PbtO2 of 5.2% (95% CI 4%-6.4%, p < 0.001) for a 10 mmHg increase in ICP below 22 mmHg and a decrease of 5.5% (95% CI 2.7%-8.3%, p=<0.001) in PbtO2 for a 10 mmHg increase in ICP above 22 mmHg. As well as a decrease of 40.9% (95% CI 2.3%-64.3%, p = 0.040) in PbtO2 per day in the intensive care unit.
UNASSIGNED: This model demonstrates that there is a significant non-linear relationship between ICP and PbtO2, however, this is a small heterogeneous cohort and further validation will be required.
UNASSIGNED: Understanding the complex relationship between PbtO2 and ICP for patients with traumatic brain injury will enable better clinical decision making beyond simple threshold treatment strategies.
UNASSIGNED: Patients with PbtO2 monitoring were identified from the BrainIT database, a multi-centre dataset, containing minute by minute PbtO2 and ICP readings. Missing data was imputed and a multi-level log-normal regression model with a compound symmetry correlation structure was built. This accounted for any increased correlation due to the repeated measurements. The model was adjusted for mean arterial pressure and the partial pressure of carbon dioxide. Non-linearity was assessed using analysis of deviance and trends using expected marginal means.
UNASSIGNED: 11 subjects with over 82,000 readings were included. They had a median age of 38 (IQR: 37-47), 73% were male, a median length of stay of 11.8 (IQR: 6.6-19.7) days and a median extended Glasgow outcome scale of 7.00 (IQR: 5-8).There is a statistically significant (p < 0.001) non-linear effect of ICP on PbtO2. With an overall increase in PbtO2 of 5.2% (95% CI 4%-6.4%, p < 0.001) for a 10 mmHg increase in ICP below 22 mmHg and a decrease of 5.5% (95% CI 2.7%-8.3%, p=<0.001) in PbtO2 for a 10 mmHg increase in ICP above 22 mmHg. As well as a decrease of 40.9% (95% CI 2.3%-64.3%, p = 0.040) in PbtO2 per day in the intensive care unit.
UNASSIGNED: This model demonstrates that there is a significant non-linear relationship between ICP and PbtO2, however, this is a small heterogeneous cohort and further validation will be required.
摘要：
■脑组织氧分压（PbtO2）已被证明是一种安全的有效监测方式，可以辅助颅内压（ICP）监测。它与代谢活动有关，疾病严重程度和死亡率。
■了解脑外伤患者PbtO2与ICP之间的复杂关系，将能够在简单的阈值治疗策略之外做出更好的临床决策。
■从BrainIT数据库中确定有PbtO2监测的患者，多中心数据集，包含每分钟的PbtO2和ICP读数。对缺失数据进行了估算，并建立了具有复合对称相关结构的多水平对数正态回归模型。这解释了由于重复测量而导致的任何增加的相关性。调整模型的平均动脉压和二氧化碳分压。非线性是通过使用预期边际手段对偏差和趋势进行分析来评估的。
■包括11位读数超过82,000的受试者。他们的平均年龄为38岁（IQR：37-47），73%是男性，中位住院时间为11.8天(IQR:6.6-19.7),延长格拉斯哥结局量表的中位住院时间为7.00天(IQR:5-8).ICP对PbtO2有统计学显著的(p<0.001)非线性效应。PbtO2总体增加5.2%(95%CI4%-6.4%，p<0.001），ICP升高10mmHg，低于22mmHg，降低5.5％（95％CI2.7％-8.3％，PbtO2中p=<0.001），ICP增加10mmHg，高于22mmHg。以及下降40.9%（95%CI2.3%-64.3%，p=0.040）在重症监护病房中每天的PbtO2。
■该模型表明，ICP和PbtO2之间存在显着的非线性关系，但是，这是一个小型异质队列,需要进一步验证.
■了解脑外伤患者PbtO2与ICP之间的复杂关系，将能够在简单的阈值治疗策略之外做出更好的临床决策。
■从BrainIT数据库中确定有PbtO2监测的患者，多中心数据集，包含每分钟的PbtO2和ICP读数。对缺失数据进行了估算，并建立了具有复合对称相关结构的多水平对数正态回归模型。这解释了由于重复测量而导致的任何增加的相关性。调整模型的平均动脉压和二氧化碳分压。非线性是通过使用预期边际手段对偏差和趋势进行分析来评估的。
■包括11位读数超过82,000的受试者。他们的平均年龄为38岁（IQR：37-47），73%是男性，中位住院时间为11.8天(IQR:6.6-19.7),延长格拉斯哥结局量表的中位住院时间为7.00天(IQR:5-8).ICP对PbtO2有统计学显著的(p<0.001)非线性效应。PbtO2总体增加5.2%(95%CI4%-6.4%，p<0.001），ICP升高10mmHg，低于22mmHg，降低5.5％（95％CI2.7％-8.3％，PbtO2中p=<0.001），ICP增加10mmHg，高于22mmHg。以及下降40.9%（95%CI2.3%-64.3%，p=0.040）在重症监护病房中每天的PbtO2。
■该模型表明，ICP和PbtO2之间存在显着的非线性关系，但是，这是一个小型异质队列,需要进一步验证.
