Abnormality of PaO2 and FiO2 Ratio and Clinical Outcome of Severe Traumatic Brain Injury

Desin Pambudi Sejahtera(1*), Ismail Setyopranoto(2), Indarwati Setyaningsih(3), Sri Sutarni(4), Tri Ratnaningsih(5)

(1) Department of Neurology. Faculty of Medicine, Public Health & Nursing. Universitas Gadjah Mada. Yogyakarta.
(2) Department of Neurology. Faculty of Medicine Public Health & Nursing. Universitas Gadjah Mada. Yogyakarta.
(3) Department of Neurology. Faculty of Medicine, Public Health & Nursing. Universitas Gadjah Mada. Yogyakarta.
(4) Department of Neurology. Faculty of Medicine, Public Health & Nursing. Universitas Gadjah Mada. Yogyakarta.
(5) Department of Clinical Pathology, Faculty of Medicine, Public Health & Nursing, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author



An accurate prognosis of severe traumatic brain injury (TBI) is still one of the  important challenge for neurologist in order to make a proper decision and good education for patients.


Evaluation and assessment the correlation abnormality PaO2 and FiO2 ratio of arterial blood gas analysis (ABG) and the outcome (mortality) of severe TBI.


In this study, we reviewed the medical records data from severe TBI cases in Sardjito General Hospital from January 2015 untill July 2016. The data consists of age, gender, neuroimaging, ABG, electrolyte, and mortality. Chi square analytic and logistic regression were used to analyse the data significancy and potential confounding factor determination.


Seventy patients of Severe TBI and 35 of them were died. The analysis of each components and interpretation of ABG showed no significancy between ABG and the mortality of severe TBI. Other factors that has prognostic significance were under 40 of age (OR=1.143, p=0,015), multiple injury (OR=5.712, p=0,045), sistolic blood pressure (OR=3.852, p=0,008), hyponatremia (OR=3.667, p=0,027), hypercalemia (OR=1.771, p=0,030) and subarachnoid hemorrhage (SAH) (OR=6,526, p=0,003).


Abnormality of PaO2 and FiO2 ratio may not be used as the outcome predictor for severe TBI patients, meanwhile multiple injury, sistolic blood pressure, hyponatremia and SAH may has prognostic value as mortality predictor.


PaO2 and FiO2 ratio, arterial blood gas analysis, mortality, severe traumatic brain injury


PaO2 and FiO2 ratio, arterial blood gas analysis, mortality, severe traumatic brain injury


Avarello JT, Cantor RM. Pediatric Major Trauma: An Approach to Evaluation and Management. Emerg Med Clin North Am.2007;803–836.

Marik PE, Varon J, Trask T. Management of Head Trauma, Chest. 2002;122;699-711.

Frey KL, Rojas DC, Anderson A, Arciniegas DB. Comparison of the O-log and GOAT as Measures of Posttraumatic Amnesia. Brain Injury.2007;21;513-520.

Irawan H, Setiawan F, Dewi, Dewanto G. Perbandingan Glsagow Coma Scale dan Revised Trauma Score dalam memprediksi Disabilitas pasien trauma kepala di Rumah Sakit Atma Jaya. Majalah Kedokteran Indonesia.2010;10.

Japardi I. Penatalaksanaan cedera kepala akut, digitized by USU digital library.2002.

Coronado VG, Basavaraju SV, McGuire LC, et al. Surveillance for Traumatic Brain injury-Related death. MMWR United States.2011;60(5);1-36.

Moppett IK. Traumatic brain injury: assessment, resuscitation and early management. Br J Anaesth.2007;99;18–31

McHugh GS, Engel DC, Butcher I, Steyerberg EW, Lu J, Mushkudiani N, Hernández AV, Marmarou A, Maas AIR, Murray GD. Prognostic Value of Secondary Insults in Traumatic Brain Injury: Results from The IMPACT Study. J Neurotrauma 24.2007:287–293

Bader MK. Recognizing and treating ischemic insults to the brain: the role of brain tissue oxygen monitoring. Critical Care Nursing Clinics of North America. 2006;18;243-256.

Barton CW, Hemphill JC, Morabito D, Manley G. A novel method of evaluating the impact of secondary brain insults on functional outcomes in traumatic brain-injured patients. Academy of Emergency Medicine 2005;12(1);1-6.

Perhimpunan Dokter Spesialis Saraf Indonesia, Konsensus Nasional Penanganan trauma kapitis dan trauma spinal. Bagian neurologi FK UI/RSCM Jakarta 2006.

Lang E.W., Czosnyka, M., & Mehdorn, M. Tissue oxygen reactivity and cerebral auto-regulation after severe traumatic brain injury. Neurologic Critical Care 31(1), 2003, 267-271

Stocchetti, N., Furlan, A., & Volta, F.. Hypoxemia and arterial hypotension at the accident scene in head injury. The Journal of Trauma, 40(5), 1996. 764-767.

Valadka, A.B. & Robertson, C.S. Surgery of cerebral trauma and associated critical care. Neurosurgery, 61 (1), 2007, SHC 203-221.

Sastrodiningrat, A.G.. Pemahaman Indikator-Indikator Dini dalam Menetukan Prognosa Cedera Kepala Berat, 2007, Medan 20-25.

Dumont, T.M., Visioni AJ, Rughani AI, Tranmer BI, Crookes B.. Inappropriate prehospital ventilation in severe traumatic brain injury increases in-hospital mortality. J Neurotrauma 2010; 27:1233-41

Henzler, D., Cooper, D.J., Mason, K. Factors contributing to fatal outcome of traumatic brain injury: a pilot case control study. Crit Care Resusc 2001; 3:153-7.

V.V., P. et al., Impact of pre-hospital oxygenation and ventilation status on outcome in patients with isolated severe traumatic brain injury. Signa Vitae, 9(1), 2014.pp.42–46. Available at: http://www.signavitae.com/attachments/07 STRNAD-VUJANOVIC - SIGNA26.pdfnhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed12&NEWS=N&AN=2014305493

Van Putten, H.P., Bouwhuis, M.G., Muizelaar, J.P., Lyeth, B.G., Berman, R.F. Diffusion Weighted Imaging of Edema following Traumatic Brain Injury in Rats: Effects of Secondary Hypoxia. J Neurotrauma 2005. 22:857–872

Rastegar. A Clinical utility of Stewart’s method in diagnosis and management of acid-base disorders. Clin J Am Soc Nephrol 2009;4:1267-74

Elf, K. Secondary Insults in Neurointensive Care of Patients with Traumatic Brain Injury. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 20, 2005, 78 pp. Uppsala. Acta Universitatis Upsaliensis.

Farace, E. & Alves, W.M. Do women fare worse? A meta analysis of gender differences in outcome after traumatic brain injury, Neurosurgery focus; 8;1; 2000.

Guerra, M., Del Castillo, A.R., Battaner, E., Mas, M., Androgens stimulate preoptic area Na-K- ATPase activity in male rats. Neurosci Lett 78 1987: 97–100.

Ghebrehiwet, M., Quan, L.H., Andebirhan. The profile of CTscan findings in acute head trauma in Orotta hospital, Journal of Eritrean medical association JEMA 2009;5-8.

Cheng, P.L., Lin, H.Y., Lee, Y.K., Hsu, C.Y., Lee, C.C., et al.. Scandinavian Journal of Trauma 2014, 22;7

Lingsma, H.F., Roozenbeek, B., Steyerberg, E.W., Murray, G.D., Maas, A.I.. Early prognosis in traumatic brain injury : from prophecies to predictions, Lancet neurology 2010; 9: 543-54

Sarrafzadeh, A.S., Peltonen, E.E., Kaisers, U., Kuchler, U., Lanksch, W.R., et al.. Secondary insults in severe head injury: Do multiply injured patients do worse? Crit Care Med 2001, 29;1;116-123

Sellmann, T., Miersch, D., Kienbaum, P., Flohé, S., Schneppendahl, J., et al. The impact of arterial hypertension on polytrauma and traumatic brain injury. Dtsch Arztebl Int 2012; 109(49): 849−56.

Rixen, D., Steinhausen, E., Dahmen, J., Boullion, B., S3-Leitlinie Polytrauma/ Schwerverletzten-Behandlung der DGU. Unfallchir 115(1) 2012.: 22.

Manley, G., Knudson, M.M., Morabito, D., Damron, S., Erickson, V. Hypotension, hypoxia, and head injury frequency, duration and cosequency, Arch Surg. 2001. 136(10);1118-1123.

Yang, C.J., Hsiao, K.Y., Su, I.C., Chen, I.C. The association between anemia and the mortality of severe traumatic brain injury in emergency department, J trauma, 2011.71(6);132-135.

Sekhon, M.S., Mclean, N., Henderson, W.R., Chittock, D.R.,Griesdale, D.E.G. Association of hemoglobin concentration and mortality in critically ill patients with severe traumatic brain injury, Critical Care 2012., 16;1-7.

Hare, G.M., Mazer, C.D., Hutchison, J.S., McLaren, A.T., Liu, E., et al.. Severe hemodilutional anemia increases cerebral tissue injury following acute neurotrauma. J Appl Physiol 2007, 103:1021-1029.

Andriani R., Wibowo S., Rusdi I.. Lekositosis sebagai prediktor outcome pada penderita cedera kepala. Bagian I.P. Saraf Fakultas Kedokteran Universitas Gadjah Mada/RSUP DR Sardjito, 2009. Yogyakarta.

Schnuriger, B., Inaba, K., Abdelsayed, G.A., Lustenberger, T., Eberle, B.M., et al.. The impact of platelets on the progression of traumatic intracranial hemorrhage. J trauma; 2010. 68(4);881-885.

El-Dabah, F.H & Elgebali, M.E. Hyponatremia in acute head injury: Correlation with severity and mortality. Curr. Res. Neurosci., 2013. 1-5

Moro, N., Katayama, Y., Igarashi, T., et al. Hyponatremia in patients with traumatic brain injury: incidence, mechanism, and respon to sodium supplementation or retention therapy with hydrocortisone. Surgical Neurology 2006, 68; 387-393.

Nurhidayati, E., Setyaningsih, I., Was’an, M.. Hipoalbuminemia sebgai prediktor kematian cedera kepala berat, Bagian I.P. Saraf Fakultas Kedokteran Universitas Gadjah Mada/RSUP DR Sardjito, 2012. Yogyakarta

Dhandhapani, S., Manju, D., Vivekanandhan, S., Sharma, B.S., Mahapatra, A.K.. Prognostic value of admission serum albumin levels in patients with head injury. Pan Aran Journal of Neurosurgery 2009, 13;1;60-65

Biolo, G., Toigo, G., Ciocchi, B., Situlin, R., Iscra, F., et al. Metabolic respon to injury and sepsis : changes in protein metabolism. Nutrition 1997, 13;9, 538-578.

Callosum, T., Harsono, Setyaninsih, I. Trombositopenia sebagai prediktor kematian cedera kepala berat, Bagian I.P. Saraf Fakultas Kedokteran Universitas Gadjah Mada/RSUP DR Sardjito, 2014. Yogyakarta

Rahimi, S., Bidabadi, E. & Mashouf, M., Prognostic value of arterial blood gas disturbances for in-hospital mortality in pediatric patients with severe traumatic brain injury., 2014.pp.187–192.

Bardt TF, Unterberg AW, Härtl R, Kiening KL, Schneider GH, Lanksch WR. Monitoring of brain tissue PO2 in traumatic brain injury: effect of cerebral hypoxia on outcome. 1998. Acta Neurochir Suppl. 1998;71:153-6.

Stiefel MF, Spiotta A, Gracias VH, Garuffe AM, Guillamondegui O, Maloney-Wilensky E, Bloom S, Grady MS, LeRoux PD. 2005. Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg. 2005 Nov;103(5):805-11.

Tillman F. Bardt, A. W. Unterberg, R. Härtl, K. L. Kiening, G. H. Schneider, W. R. Lanksch. 2005. Monitoring of Brain Tissue PO2 in Traumatic Brain Injury: Effect of Cerebral Hypoxia on Outcome. Volume 71 of the series Acta Neurochirurgica Supplements pp 153-156

Van Santbrink, H., vd Brink, W., Steyerberg, E. et al. Cerebral tissue PO2 and SjvO2 changes during moderate hyperventilation in patients with severe traumatic brain injury. Acta Neurochir (2003) 145: 429. doi:10.1007/s00701-003-0032-3

M. Helm, J. Hauke, L. Lampl A prospective study of the quality of pre‐hospital emergency ventilation in patients with severe head injury.Br. J. Anaesth. 2002 88 (3): 345-349. doi: 10.1093/bja/88.3.345

Milla Jousi, Janne Reitala, Vesa Lund, Ari Katila, Ari Leppäniemi. The role of pre-hospital blood gas analysis in trauma resuscitation. World Journal of Emergency Surgery 2010. 5:10. DOI: 10.1186/1749-7922-5-10

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