Multifactorial study on type Ⅱ respiratory failure and persistent contralateral subdural effu-sion after craniectomy for traumatic brain injury

Wang Yanglingxi; Zhou Weiduo; Chen Peng; He Qi; Deng Yongbing

doi:10.3969/j.issn.1009-4237.2025.08.010

Abstract：Objective To investigate the correlation between type Ⅱ respiratory failure(type Ⅱ RF)and refractory contralateral subdural effusion(CSDE)in patients with traumatic brain injuries(TBI)who developed CS-DE after decompressive craniectomy,in order to determine whether type Ⅱ RF contributes to the progression of CS-DE.Methods This was a single-center retrospective study that reviewed the clinical and imaging data of 108 TBI patients who developed CSDE following DC at our department between Jun.30,2013 and Dec.11,2022.The cohort comprised 79 males and 29 females aged 18 to 89(mean 49.1)years.The TBI causes included road traffic acci-dents(45 cases),falls from height(30 cases),assault(10 cases),sports injuries(8 cases),and others(15 ca-ses).The primary outcome was set as whether CSDE progressed to refractory CSDE and required surgical interven-tion within 3 weeks after DC.Univariate analysis was performed to identify factors associated with the development of refractory CSDE.A multivariate logistic regression model was subsequently constructed to evaluate the independ-ent association between type Ⅱ RF and refractory CSDE.Subgroup analysis was further conducted to assess the stratified and interactive effects of type Ⅱ RF on the progression of CSDE to refractory CSDE.Results Of the 108 TBI patients who developed CSDE after DC,34 progressed to refractory CSDE(31.5％),and 43 patients(39.8％)had type Ⅱ RF.Variables significantly associated with the development of refractory CSDE included peak body tem-perature during hospitalization(38.8℃±1.6℃),admission GCS score(8.9±2.7),preoperative GCS score(7.9±2.4),highest preoperative ICP(16.0 mmHg,range 0-18.0 mmHg),occurrence of type Ⅱ RF during hospi-talization(43 cases,39.8％),interval from TBI to DC(6.0 h,IQR 4.0-11.2 h),maximum width of CSDE within 3 d postoperatively(3.5 mm,IQR 2.5-5.1 mm),and midline shift(3.0 mm,IQR 0-6.0 mm).Multivariate logistic regression analysis showed that patients with type Ⅱ RF had a 3.639-fold increased risk of developing refractory CS-DE compared to those without type Ⅱ RF(95％CI:1.395-9.488).Furthermore,among patients with elevated pre-operative ICP(≥ 15 mmHg),the risk of developing refractory CSDE following type Ⅱ RF was 8.976 times higher than in those with lower ICP(＜15 mmHg)(95％CI:1.982-40.758).Conclusion In TBI patients who develop CSDE after DC,type Ⅱ RF is significantly associated with the progression of CSDE to refractory CSDE.This risk is particularly elevated in patients with elevated preoperative ICP.