ABSTRACT 351

Abstract

Background and aims: A minimum cerebral perfusion pressure (CPP) of 40 mm Hg is acceptable in children with traumatic brain injury. Optimal CPP threshold in acute CNS infections remain undefined. Aims: To identify the impact of different CPP thresholds on mortality in children with acute CNS infections. Methods: Design: Retrospective analysis of prospectively collected data in level-III PICU. Subjects: 231 children, aged 1–12 years, with raised ICP and modified-GCS Score ≤ 8. Interventions: ICP monitoring using intraparenchymal microtransducer (Codman®). CPP was targeted by fluid boluses, vasopressors and anti-raised-ICP measures. Based on mean CPP in first 72 hours, patients were divided into Groups I (30–40) (n=25), II (41–50) (n=31), III (51–60) (n=56) and IV (≥60) (n=119). Outcomes: Primary: 90-day mortality. Secondary: 72-hour m-GCS score, length of mechanical ventilation, PICU stay, and functional status at 3 months. Statistics: Cox-regression adjusted for age, sex, diagnosis, PRISM-III, opening ICP, PRBC transfusion and osmotherapy. Department review committee approved the study. Results: 90-day-mortality was lower in Group IV (13.4%) than Groups I (96.2%; adjusted HR=16.75, 95% CI 8.75–32, p<0.001), II (64.5%; adjusted HR=7.38, 95% CI 3.8–14.35, p<0.001), III (32.7%; adjusted HR=2.4, 95% CI 1.41–5.37, p=0.003). Median m-GCS score was higher in Group IV (10; IQR 8–11) than others (<8) (p<0.001). Length of mechanical ventilation (Log-rank p<0.001) and PICU stay (Log-rank p<0.001) were lower in Group IV. Intact survival at 3 months was higher in Group-IV (54/103, 52.4%) than others (p<0.001). Conclusions: CPP ≥ 60 mm Hg is independently associated with lower mortality in children with acute CNS infections.