• Peter R A Gerges, Lynne Moore, Caroline Léger, François Lauzier, Michèle Shemilt, Ryan Zarychanski, Damon C Scales, Burns Karen E A KEA Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. , Francis Bernard, David Zygun, Xavier Neveu, Alexis F Turgeon, and Canadian Critical Care Trials Group.
• CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, 1401, 18e rue, local Z-204, Québec City, QC, G1J 1Z4, Canada.
• Can J Anaesth. 2018 Sep 1; 65 (9): 996-1003.

PurposeThe intensity of care provided to critically ill patients has been shown to be associated with mortality. In patients with traumatic brain injury (TBI), specialized neurocritical care is often required, but whether it affects clinically significant outcomes is unknown. We aimed to determine the association of the intensity of care on mortality and the incidence of withdrawal of life-sustaining therapies in critically ill patients with severe TBI.MethodsWe conducted a post hoc analysis of a multicentre retrospective cohort study of critically ill adult patients with severe TBI. We defined the intensity of care as a daily cumulative sum of interventions during the intensive care unit stay. Our outcome measures were all-cause hospital mortality and the incidence of withdrawal of life-sustaining therapies.ResultsSeven hundred sixteen severe TBI patients were included in our study. Most were male (77%) with a mean (standard deviation) age of 42 (20.5) yr and a median [interquartile range] Glasgow Coma Scale score of 3 [3-6]. Our results showed an association between the intensity of care and mortality (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.63 to 0.74) and the incidence of withdrawal of life-sustaining therapy (HR, 0.73; 95% CI, 0.67 to 0.79).ConclusionIn general, more intense care was associated with fewer deaths and a lower incidence of withdrawal of life-sustaining therapies in critically ill patients with severe TBI.

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