Craniectomía descompresiva y compliance intracraneal en el traumatismo craneoencefálico grave pediátrico

Abstract

ObjectiveTo show the effect of primary decompressive craniectomy on ICP, CPP, and intracranial compliance in a group of pediatric patients who suffered from severe head trauma. DesignDescriptive study. FrameworkPediatric intensive care. PatientsPediatric patients who underwent primary decompressive craniectomy due to severe head trauma, admitted to the pediatric intensive care unit of the “Roberto Rodríguez Fernandez” general teaching hospital in Morón, Ciego de Avila, Cuba between January 2003 and December 2017. ResultsDiffuse brain injury Grade IV, was the most frequent tomographic diagnosis at admission 18 (60%), with a predominance of shifts greater than 6mm in 24 cases (80%) and absent cisterns 15 (50%). Eighteen cases (60%) had normal ICP for their age after craniectomy, 20 (66.7%) cases showed normal cerebral perfusion pressure. There was a correlation between normal ICP and normal intracranial compliances. The pulse wave amplitude was used as a neuromonitoring method and qualitative representation of compliances. Twenty-two cases survived (73.3%), 18 (60%) of them without sequelae. Eight cases died (26.7%). ConclusionsPrimary DC was useful for the control of ICP and maintenance of CPP in the management of pediatric patients with severe TBI in the present study. The favorable effect of the procedure for the increase of intracranial compliance has been verified.