Abstract
Traumatic brain injury is the leading cause of death in children. Children with severe TBI are in need of neurointensive care where the goal is to prevent secondary brain injury by avoiding secondary insults. Monitoring of cerebral blood flow (CBF) and autoregulation in the injured brain is crucial. However, there are limited studies performed in children to investigate this. Current studies report on age dependent increase in CBF with narrow age range. Low initial CBF following TBI has been correlated to poor outcome and may be more prevalent than hyperemia as previously suggested. Impaired cerebral pressure autoregulation is also detected and correlated with poor outcome but it remains to be elucidated if there is a causal relationship. Current studies are few and mainly based on small number of patients between the age of 0–18 years. Considering the changes of CBF and cerebral pressure autoregulation with increasing age, larger studies with more narrow age ranges and multimodality monitoring are required in order to generate data that can optimize the therapy and clinical management of children suffering TBI.
Highlights
Traumatic brain injury is a leading cause of death among children and affects children all over the world
The relationships between ICP, mean arterial pressure (MAP), CPP, and cerebral blood flow (CBF) can be straightforward in the healthy brain it is more complex in the injured brain in particular in the developing brain
This study reported on normal values, the included children had underlying diagnoses such as Moyamoya disease, skull deformity and craniosynostosis, but they had normal development and no signs of intracranial hypertension
Summary
Traumatic brain injury is a leading cause of death among children and affects children all over the world. The goal of TBI management in the acute setting is to prevent secondary insults and brain injuries by achieving adequate CBF [6] This is mainly achieved by monitoring of ICP and CPP to optimize CBF, which is crucial in order to deliver substrates to the injured brain. The relationships between ICP, MAP, CPP, and CBF can be straightforward in the healthy brain it is more complex in the injured brain in particular in the developing brain Many physiological parameters such as CO2 reactivity, O2 reactivity, and cerebral pressure autoregulation can be disturbed and compromise the need of adequate substrate delivery. Verlhac who used transcranial Doppler (TCD) found that the CBF velocity in MCA increased with age starting in newborns at around 24 cm/s and peaking in 6–10 years of age to 97 cm/s This was followed by a decrease in older children (age 10–16.9 years) to 81 cm/s [21]. Using perfusion CT in 77 children aged 7 months to 18 years, Wintermark et al found values of 40 ml/100 g/min at 6 months with a peak of 130 ml/100 g/min at 2–4 years of age that stabilized
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