Page 55 - NNS 2014 Program & Abstract Book

Monitoring of PbtO2 in the adult sTBI population may be predictive
of 3 month neurological outcome and providing a target cohort for
early rehabilitation efforts. Additional studies are needed to assess the
effectiveness of treating PbtO2 values.
Key words
brain oxygenation, clinical, neurological outcome
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INFLUENCE OF SYSTEMIC GLUCOSE ON KETOGENIC
METABOLITES
Wolahan, S.M.1,2, MacFarlane, M.P.1,2, McArthur, D.L.1,2, Vespa,
P.1,2, Martin, N.A.1,2, Glenn, T.C.1,2
1Brain Injury Research Center, Los Angeles, CA
2UCLA, Los Angeles, CA
Maintaining blood glucose below hyperglycemic (200 mg/dL) and
above hypoglycemic levels (80 mg/dL) is a critical aspect of post-TBI
care. Research on modulating patients’ blood glucose to low glycemic
ranges (80–110 mg/dL) has produced conflicting results regarding out-
come. The objective of this study is to investigate metabolic changes
beyond systemic glucose under low glycemia. Arterial and jugular ve-
nous blood plasma and CSF were repeatedly collected from fifteen
patients following severe head injuries (3 females, age 39 – 16, GCSER
6.8 – 4.2). Clinical glucose measurements approximated periods of low
glycemia ( £ 115 mg/dL) and of moderate glycemia ( > 115 mg/dL)
during the first ten days following injury; all 15 patients included had
biofluids collected during both periods. Biofluid metabolite concentra-
tions were determined by NMR spectroscopy. Blood glucose decreased
at low glycemic levels (103 – 19 from 145 – 21 mg/dL). Systemic ketone
bodies were increased at low glycemic levels (b-hydroxybutyrate ( b-HB)
128 – 130 to 222 – 235 lM; acetoacetic acid(AcAc) 66 – 85 to 115 –
152 lM) but a robust, dependent yuen test did not reveal statistical
significance. We used mixed effects models (MEM) to account for
repeated collection/measurement and to investigate the effect of low
glycemia on biofluid metabolites and their relationship between bio-
fluids. MEM of AcAc concentration with the fixed effects of glycemic
level, post-injury hour (PIH), biofluid compartment, and the interaction
between glycemic level and PIH revealed a significant increase in AcAc
at low glycemic levels (202 – 41 lM, p <0.001), a significant decrease in
CSF AcAc compared to plasma ( - 77 – 16 lM, p < 0.001), and a sig-
nificant interaction between glycemic level and PIH ( - 1.2 – 0.4 lM,
p = 0.002). b-HB concentration modeling with the fixed effects of gly-
cemic level, PIH, biofluid compartment, and the interactions of glycemic
level with PIH and with biofluid location revealed a significant increase
in b-HB at low glycemic levels (438 – 98 lM, p < 0.001) and a sig-
nificant interaction between glycemic level and PIH ( - 2.4 – 0.7 lM,
p < 0.001). These results suggest the body increases ketone production at
low glycemic levels and does so to a greater degree at early PIH.
Key words
glycemia, ketones, metabolite
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THE INDO-US COLLABORATIVE HEAD INJURY AND
ADHERENCE TO GUIDELINES (CHIRAG) PROJECT: OUT-
COMES AND FEASIBILITY
Krishnamoorthy, V.1 , Sharma, D.1 , Rowhani-Rahbar, A.1, Kannan,
N.1, Gupta, D.2, Mahapatra, A.2, Pandey, H.2, Mock, C.1, Vavilala, M.1
1University of Washington, Seattle, USA
2Jai Prakash Narain Apex Centre, All India Institute of Medical
Sciences, New Delhi, India
Traumatic brain injury (TBI) is a major public health problem in
both the U.S. and India. The CHIRAG project examines the rela-
tionship between adherence to the 2007 Brain Trauma Foundation
Guidelines and outcomes in severe TBI patients at Harborview
Medical Center (HMC, Seattle) and JPN Apex Trauma Center ( JPN,
New Delhi). Here, we report results on clinical characteristics and
both short-term and long-term outcomes at JPN, as well as project
feasibility.
After separate local IRB approvals were obtained, we conducted a
prospective study with one-year patient follow-up at JPN between
2012–2014 to assess guideline adherence and outcomes after severe
TBI; for comparison, similar data was collected retrospectively
from severe TBI patients admitted to HMC. Inclusion criteria were:
age ‡ 18 years, admission Glasgow Coma Scale (GCS) score < 9 and
head Abbreviated Injury Score (AIS) ‡ 3, intubated in intensive care
unit (ICU) ‡ 48 hours and no CPR prior to admission.
At JPN, 200 patients were enrolled prospectively over two years.
Table 1 shows the clinical characteristics of enrolled patients, both at
HMC and JPN. Overall, JPN patients were younger and had less
polytrauma. Compared to local HMC mortality rates, discharge
mortality was similar; however, post-discharge outcomes (including
both mortality and neurologic improvement) appeared worse in the
JPN group.
Success with the CHIRAG project suggests that joint Indo-US TBI
studies are feasible. Descriptive analysis suggests some baseline
differences in clinical characteristics of severe TBI patients per-
taining to extracranial injury and injury severity. While discharge
mortality was similar between HMC and JPN, post-discharge out-
comes appeared worse in the JPN group. Future research should
address post-hospital discharge factors that may improve outcomes
in this population.
Key words
global health, outcomes, TBI
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NEUROPHYSIOLOGICAL TESTING FOR LONG-TERM
PROGNOSIS IN SEVERE TRAUMATIC BRAIN INJURED
PATIENTS
Bauer, J.S.1, Panczykowski, D.M.2 , Zusman, B.1, Zeh, R.1, Winek, N.1,
Puccio, A.M.1, Balzer, J.1,2, Okonkwo, D.O.1,2
1University of Pittsburgh School of Medicine, Pittsburgh, US
2UPMC Department of Neurosurgery, Pittsburgh, US
Prognostication in the acute phase of severe traumatic brain injury
(TBI) remains difficult. Somatosensory evoked potentials (SSEPs) as
a neurophysiologic testing modality may provide a reliable objective
mechanism for TBI prognostication. Under an IRB-approved proto-
col, prospective clinical and outcome data were collected from all
severe TBI patients (Glasgow Coma Score £ 8) admitted to UPMC
between 2006–2011. SEP recording was performed on post-trauma
day 5. N9, N13, P14, N20, and P30 latencies are measured; central
conduction time (CCT) is defined as the delay between the P14 peak
recorded at the C-2 electrode and the N20 peak recorded at the so-
matosensory cortex. Peak-to-peak amplitudes measured are of N20/
P30 using Fz reference. Criterion for pathologic SEP event was de-
fined as either the reduction of the N20 amplitude below 50% of
baseline or the increase of latency between P14 and N20 by 10%.
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