Brain tissue oxygen combined with intracranial pressure monitoring in patients with severe traumatic brain injury: An updated systematic review and meta-analysis following the OXY-TC trial.

Abstract

Introduction: Severe traumatic brain injury (TBI) is associated with high mortality and long-term disability. Effective TBI management, aimed at minimizing secondary brain damage, requires constant monitoring of intracranial pressure (ICP) with or without brain tissue oxygen pressure (PbtO2). The recent OXY-TC trial suggested that combined ICP + PbtO2 monitoring does not improve the 6-month neurological outcomes, prompting a meta-analysis to reassess the clinical role of PbtO2 monitoring.

Methods: We conducted systematic review and meta-analysis by searching the PubMed, Medline, and Cochrane databases for randomized controlled trials and prospective studies on adult severe TBI patients, comparing clinical outcomes of ICP monitoring alone versus ICP + PbtO2 monitoring. Data extraction and quality assessments were performed independently by two reviewers. Meta-analyses were conducted using a random-effects model, focusing on 6-month mortality and favorable functional outcomes.

Results: Six studies met the inclusion criteria. The ICP + PbtO2 group is more likely to have favorable outcomes (OR: 1.39, 95% CI: 1.01-1.92, I² = 0%) 6 months following TBI. There were no statistically significant differences in the 6-month mortality (odds ratio, OR: 0.75, 95% confidence interval, CI: 0.52-1.10; I² = 0%).

Conclusion: Our research findings partially align with the OXY-TC trial regarding the primary endpoint, demonstrating that brain tissue oxygen-guided therapy does not significantly reduce mortality rates in TBI patients 6 months post-injury. However, in contrast to the OXY-TC trial, we observed that the PbtO2 monitoring group showed a significantly higher proportion of favorable outcomes.