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Association of Early Myocardial Workload and Mortality Following Severe Traumatic Brain Injury*
| Content Provider | Scilit |
|---|---|
| Author | Krishnamoorthy, Vijay Vavilala, Monica S. Chaikittisilpa, Nophanan Rivara, Frederick P. Temkin, Nancy R. Lele, Abhijit V. Gibbons, Edward F. Rowhani-Rahbar, Ali |
| Copyright Year | 2018 |
| Description | Journal: Critical Care Medicine Objectives: To examine the impact of early myocardial workload on in-hospital mortality following isolated severe traumatic brain injury. Design: Retrospective cohort study. Setting: Data from the National Trauma Databank, a multicenter trauma registry operated by the American College of Surgeons, from 2007 to 2014. Patients: Adult patients with isolated severe traumatic brain injury (defined as admission Glasgow Coma Scale < 8 and head Abbreviated Injury Score ≥ 4). Interventions: Admission rate-pressure product, categorized into five levels based on published low, normal, and submaximal human thresholds: less than 5,000; 5,000–9,999; 10,000–14,999; 15,000–19,999; and greater than 20,000. Measurements and Main Results: Data from 26,412 patients were analyzed. Most patients had a normal rate-pressure product (43%), 35% had elevated rate-pressure product, and 22% had depressed rate-pressure product at hospital admission. Compared with the normal rate-pressure product group, in-hospital mortality was 22 percentage points higher in the lowest rate-pressure product group (cumulative mortality, 50.2%; 95% CI, 43.6–56.9%) and 11 percentage points higher in the highest rate-pressure product group (cumulative mortality, 39.2%; 95% CI, 37.4–40.9%). The lowest rate-pressure product group was associated with a 50% increased risk of mortality, compared with the normal rate-pressure product group (adjusted relative risk, 1.50; 95% CI, 1.31–1.76%; p < 0.0001), and the highest rate-pressure product group was associated with a 25% increased risk of mortality, compared with the normal rate-pressure product group (adjusted relative risk, 1.25; 95% CI, 1.18–1.92%; p < 0.0001). This relationship was blunted with increasing age. Among patients with normotension, those with depressed and elevated rate-pressure products experienced increased mortality. Conclusions: Adults with severe traumatic brain injury experience heterogeneous myocardial workload profiles that have a “U-shaped” relationship with mortality, even in the presence of a normal blood pressure. Our findings are novel and suggest that cardiac performance is important following severe traumatic brain injury. |
| Related Links | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5953788/pdf |
| Ending Page | 971 |
| Page Count | 7 |
| Starting Page | 965 |
| ISSN | 00903493 |
| e-ISSN | 15300293 |
| DOI | 10.1097/ccm.0000000000003052 |
| Journal | Critical Care Medicine |
| Issue Number | 6 |
| Volume Number | 46 |
| Language | English |
| Publisher | Ovid Technologies (Wolters Kluwer Health) |
| Publisher Date | 2018-06-01 |
| Access Restriction | Open |
| Subject Keyword | Journal: Critical Care Medicine Critical Care Medicine Emergency Medicine Blood Pressure Severe Traumatic Myocardial Workload |
| Content Type | Text |
| Resource Type | Article |
| Subject | Critical Care and Intensive Care Medicine |
