UC Irvine

Background: Based on the BOOST II study and Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC) guidelines, evidence indicates that brain tissue oxygen (PbtO₂) monitoring in severe traumatic brain injury (TBI) patients results in lower mortality and improved Glasgow Outcome Scale-Extended Scores. A large academic hospital's neurocritical care unit lacks standardized PbtO₂ monitoring protocols for TBI patients despite clinical recommendations for invasive intraparenchymal catheter monitoring. Purpose: This project aimed to implement PbtO₂ monitoring in severe TBI patients and assess its impact on mortality, Glasgow Coma Scale (GCS), hospital, and ICU length of stay. Additional goals included promoting provider and nursing knowledge of PbtO2 monitoring and ensuring sustainability through policy development. Methods: This evidence-based practice project was a pre- and post-intervention design which included the implementation of a brain tissue oxygen (PbtO₂) monitoring protocol adapted from the BOOST III trial in adult severe traumatic brain injury patients. Inclusion criteria included patients with a GCS <8 admitted to the neurocritical care unit with staff education tailored by role. Outcomes including mortality rates, length of stay, and GCS scores were compared between pre- and post-implementation cohorts using retrospective chart review and non-paired t-tests over an 8–12-week period. Results: No statistically significant differences were found between the pre and post groups on any outcome measure. The study was substantially underpowered across all variables, warranting further investigation with adequately powered samples. Conclusions: This evidence-based practice project examined outcomes before and after implementation of PbtO₂ brain tissue oxygen monitoring across two independent patient cohorts (PRE, n=20; POST, n=7). Although descriptive trends favored the POST group — including lower mortality (42.9% vs. 50.0%), shorter lengths of stay among survivors, and higher GCS on arrival — no statistically significant differences were found on any outcome measure. These null findings are largely attributable to the small number of participants in the POST group. Additionally, baseline differences in injury severity between groups introduce potential confounding that limits direct comparison. These results should not be interpreted as evidence against the utility of PbtO₂ monitoring, but rather highlight the need for larger, prospective studies.