Abstract Details

Title Arterial Hyperoxia Is Associated with Poor Functional Outcome and Cognitive Impairment After TBI: A Retrospective Multi-center Cohort Study

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) S30 - Sports Neurology and Neuro Trauma (3:54 PM-4:06 PM)

Poster/Presentation
Number 003

Objective To test the hypothesis that exposure to hyperoxia after TBI would be associated with a poor functional outcome and lower cognitive performance.

Background Hyperoxia, upon admission to the ICU is associated with higher in-hospital case-fatality in critically-ill TBI patients.

Design/Methods Retrospective cohort analysis from the citicoline brain injury treatment clinical trial (COBRIT). Ventilated TBI patients who had at least one-sample of ABGs during the ICU stay. We excluded hypoxic patients and those without outcome data. Hyperoxia was defined as PaO2≥300mmHg (39.99 kPa). The primary outcome was defined as a Glasgow Outcome Score Extended (GOSE) of 1-4 at 180-days. Secondary outcomes included cognitive performance measured by components of the TBI Clinical Trials Network Core Battery, which were dichotomized at 1 standard deviation (SD) below the mean for an uninjured population (CVLT, California Verbal Learning Test; PSI, Processing Speed Index; COWA, Controlled Oral World Association Test.). Participants with raw scores </= to 1-SD than the mean of the normal population were classified as poor-outcome. We used logistic regression and calculated odds ratios (OR) and 95% confidence intervals (CI).

Results The incidence of hyperoxia was 12% (52/440). Mean age was 40+/-15 years. There were 25% (117/440) females. Hyperoxic patients had a higher probability of a poor outcome (unadjusted OR, 2.4; 95% CI, 1.3-4.4, p=0.004). After adjusting for age, gender and post-resuscitation Glasgow Coma Scale (GCS), hyperoxia was significantly associated with poor functional outcome at 180-days (adjusted OR, 2.0; 95% CI, 1.1-3.8, p=0.04). Non-significant lower cognitive performance was seen in hyperoxic patients in the following: CVLT-II (OR 1.6, 95%CI, 0.9-3.0, p=0.1); PSI (OR, 1.5, 95% CI 0.8-2.9, p=0.2); and COWA (OR, 1.3, 95% CI 0.7-2.3, p=0.5).

Conclusions

Hyperoxia during ICU stay is associated with poor long-term functional outcome and lower cognitive performance after TBI. Hyperoxia should be avoided in the early phase of resuscitation after TBI.

Authors/Disclosures
Fred Rincon, MD (Thomas Jefferson University) PRESENTER	Dr. Rincon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for NeuroCrit, LLC. Dr. Rincon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for NeuroCrit, LLC.
Mijail Serruya, MD, PhD	No disclosure on file
Jack Jallo, MD	No disclosure on file

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