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Developments in Anaesthetics & Pain Management

For Severe Traumatic Brain Injury, Thermoregulation Contributes to Controlling Cerebral Perfusion Pressure in Only 50% of Cases, Irrespective of Anesthetic Agent

Submission: September 15, 2022; Published: October 20, 2022

DOI: 10.31031/DAPM.2022.02.000538

ISSN 2640-9399
Volume2 Issue3


Traumatic Brain Injury (TBI) is a serious injury of the brain, caused by blunt forces to the cranium (as, for example, in traffic accidents). Severe TBI is life-threatening and clinicians in Intensive Care Units (ICUs) strive to avert death, minimize long-lasting damage, and enable the restoration of as many brain functions as possible post release from the ICU. In TBI patients, the difference between Mean Arterial Pressure (MAP) and Intracranial Pressure (ICP) should be above a threshold in order to maintain adequate oxygen supply to the damaged brain. One possible intervention to achieve this involves thermoregulation, often via hypothermia: cooling the body so as to increase the temperature gradient between oxygen-supplying blood and the febrile, damaged brain. Here, we investigate whether (or: to what extent) this strategy is successful, not restricting ourselves to cases of hypothermia alone.

Our analysis of the 5 vital parameters MAP, ICP, TEMP (core body temperature), etCO2 (end-tidal Carbon Dioxide, a proxy for oxygen metabolism) and HR (heart rate) of 32 TBI patients during their stay in an Intensive Care Unit (ICU) showed that relying on TEMP values for thermoregulation is not warranted.

We discovered that the above parameters are interdependent, and TEMP is not a predictor in 50% of the 12 models that were eligible as predictor models (5 further models were also examined and were excluded for statistical reasons). We also considered the possibility that the reliability of TEMP as a predictor may depend on the anesthetic agent (15 patients were administered propofol; 17 patients sevoflurane; assignment was random); we found that the unreliability does not depend on the anesthetic used. Because the interdependence of vital parameters is so high, we conclude TEMP should not be used as a predictor variable.

Keywords: TBI (Traumatic Brain Injury); ICP (Intracranial Pressure); CPP (Cerebral Perfusion Pressure); Thermoregulation; Propofol; Sevoflurane; KDE (Kernel Density Estimation) algorithms; AICc (Akaike’s Information Criterion)

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