SynthesisCritical care (London, England)2025
Impact of oxygen and carbon dioxide levels on mortality in moderate to severe traumatic brain injury: a systematic review and meta-analysis.
Synthesis in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Association of mortality and neurological outcomes with hypocapnia in adult patients with acute brain injury: an updated meta-analysis.Critical care (London, England) · 2026Pooled it
- Association between arterial to end-tidal carbon dioxide gradient and prehospital hemodynamic status in patients with moderate-to-severe traumatic brain injury.BMC emergency medicine · 2026Article
- First Breath Matters: Out-of-Hospital Mechanical Ventilation in Patients with Traumatic Brain Injury.Journal of clinical medicine · 2025Review
- A prognostic model for long-term outcome in moderate-severe traumatic brain injury using multimodal neuromonitoring: a retrospective cohort analysis.Frontiers in neurology · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTraumatic brain injury (TBI) remains a leading cause of morbidity and mortality worldwide. Secondary brain insults related to oxygenation and ventilation may affect outcomes in this high-risk population. The aim of this study was to perform a comprehensive review examining the relationship between oxygen and carbon dioxide thresholds and mortality to guide clinical care.
methodsEleven databases, including: MEDLINE, MEDLINE In-Process, Embase, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, CINAHL, APA PsycINFO, Web of Science, Biosys, Scopus, and the Global Index Medicus, were systematically searched from inception to October 23, 2024. Included studies reported on adults (≥18 years) with moderate to severe TBI (msTBI) (Glasgow Coma Scale <13 or Head Abbreviated Injury Scale ≥3) and exposure to hypoxia, hypocapnia, or hypercapnia, with mortality or vegetative state data reported within 6 months. Vegetative state data was not reported, so all analyses were based on mortality. Pediatric or mild TBI studies, stroke-focused studies, and studies without mortality outcomes were excluded. The data were screened via Covidence software with multiple reviewers. No language or regional restrictions were applied. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Quality was assessed via the Newcastle-Ottawa Scale (NOS) for Cohort Studies, and certainty of evidence was rated using GRADE. Four authors independently extracted data with verification by a second reviewer. The primary outcome was measured using odds ratios (ORs) with 95% confidence intervals (CIs), calculated separately for crude and adjusted effect estimates.
resultsTwenty-one cohort studies with 41,980 patients were included. Hypoxia and hypocapnia were significantly associated with increased mortality (aOR, 1.39; 95% CI 1.11-1.75; p =.005; aOR, 1.64; 95% CI 1.25-2.15; p <.001). Hypercapnia was not significantly associated with mortality (aOR, 1.74; 95% CI 0.91-3.32; p =.09).
conclusionsIn adults with msTBI, hypoxia and hypocapnia were independently associated with increased mortality, underscoring the importance of prompt recognition and targeted management of these secondary injuries. The role of hypercapnia remains unclear, warranting further investigation.
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