342 Brain Tissue Oxygen Plus Intracranial Pressure Monitoring Versus Isolated Intracranial Pressure Monitoring in Patients With Traumatic Brain Injury: An Updated Meta-Analysis of Randomized Controlled Trials

INTRODUCTION: Intracranial pressure (ICP) monitoring plays a key role in patients with traumatic brain injury (TBI), however, cerebral hypoxia can occur without intracranial hypertension. Aiming to improve neuroprotection in these patients, a possible alternative is the association of Brain Tissue Oxygen Pressure (PbtO2) monitoring, used to detect PbtO2 tension. METHODS: We systematically searched PubMed, Embase and Cochrane Central for RCTs comparing combined PtiO2 + ICP monitoring with ICP monitoring alone in patients with severe or moderate TBI. The outcomes analyzed were mortality at 6 months and favorable outcome (GOS = 4 or GOSE = 5) at 6 months. RESULTS: We included 5 RCTs in the analysis, totaling 575 patients. Combined PtiO2 + ICP monitoring was used in 275 (47.82%) patients. There was no significant difference between the groups in relation to favorable outcome at 6 months (RR 1.30; 95% CI 1.03-1.64; p = 0.029; I 2 = 16%), mortality at 6 months (RR 0.68; 95% CI 0.44-1.06 ; p = 0.087; I 2 = 38%). CONCLUSIONS: Our findings suggest that combined PtiO2 + ICP monitoring does not change outcomes such as mortality and functional recovery at 6 months. However, larger clinical trials need to be published to support these findings.