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Risk Factors for Intraoperative Hypotension During Decompressive Craniectomy in traumatic Brain Injury Patients
Suchada Saengrung1, Anukoon Kaewborisutsakul1, Thara Tunthanathip1
1Division of Neurosurgery, Department of Surgery, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Insights
Intraoperative hypotension (IH) during decompressive craniectomy (DC) for traumatic brain injury (TBI) is linked to low Glasgow Coma Scale motor response, high preoperative heart rate, and significant blood loss. These factors increase IH risk in TBI patients undergoing DC.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Trauma Surgery
Background:
- Decompressive craniectomy (DC) is a critical intervention for elevated intracranial pressure in traumatic brain injury (TBI).
- Intraoperative hypotension (IH) complicates DC in approximately one-third of patients, often due to reduced sympathetic activity post-decompression.
- Identifying IH predictors is crucial for managing TBI patients undergoing DC.
Purpose of the Study:
- To determine factors associated with intraoperative hypotension (IH) during decompressive craniectomy (DC).
- To investigate the relationship between IH and mortality rates in traumatic brain injury (TBI) patients undergoing DC.
Main Methods:
- Retrospective review of adult TBI patients (≥18 years) who underwent DC between January 2014 and January 2021.
- Logistic regression analysis was employed to identify factors associated with IH during DC procedures.
- Patient data included Glasgow Coma Scale motor response (GCS-M), preoperative heart rate (PHR), and intraoperative blood loss.
Main Results:
- The study included 83 TBI patients, with an IH incidence of 54%.
- Multivariate analysis revealed that GCS-M 1-3, higher PHR (≥75 bpm), and greater intraoperative blood loss were significant predictors of IH.
- Patients with GCS-M 1-3 and PHR ≥75 bpm exhibited the highest IH likelihood (77%), while those without these factors had the lowest (29%). In-hospital mortality was 44% in the IH group versus 26% in the non-IH group.
Conclusions:
- Low GCS-M (1-3), elevated preoperative heart rate, and substantial intraoperative blood loss are key risk factors for IH during DC in TBI patients.
- Close patient monitoring and preparedness for prompt resuscitation are recommended for patients with identified risk factors.
- While IH was observed more frequently in non-survivors, the difference in mortality between IH and non-IH groups was not statistically significant in this study.
Background:
Decompressive craniectomy (DC) is an important therapy for treating intracranial pressure elevation following traumatic brain injury (TBI). During this procedure, about one-third of patients become complicated with intraoperative hypotension (IH), which is associated with abruptly decreasing sympathetic activity resulting from brain decompression. This study aimed to identify factors associated with IH during DC procedures and the mortality rate in these patients.
Methods:
The records of adult TBI patients aged 18 years and older who underwent DC at Songklanagarind Hospital between January 2014 and January 2021 were retrospectively reviewed. Using logistic regression analysis, various factors were analyzed for their associations with IH during the DC procedures.
Results:
This study included 83 patients. The incidence of IH was 54%. Multivariate analysis showed that Glasgow Coma Scale motor response (GCS-M) 1-3 (vs. 4-6), higher preoperative heart rate (PHR), and larger amount of intraoperative blood loss were significantly associated with IH (P = 0.013, P < 0.001, and P < 0.001, respectively). Patients with GCS-M 1-3 and PHR ≥ 75 bpm had the highest chance of IH (77%), while patients with neither of these risk factors had the lowest chance (29%). The in-hospital mortality rate in the IH and non-IH groups was 44% and 26%, respectively (P = 0.138).
Conclusions:
GCS-M 1-3, higher PHR, and larger amount of intraoperative blood loss were the risk factors associated with IH during DC procedure in TBI patients. Patients who have these risk factors should be closely monitored and the attending physician be ready to apply prompt resuscitation and treatment for IH.
