Significance of intracranial pressure and cerebral perfusion pressure in severe pediatric traumatic brain injury

Dovilë Grinkevièiûtë,Arimantas Tamaðauskas,Rimantas Këvalas,Vytautas Ragaiðis,Algimantas Matukevièius

doi:10.3390/medicina44020015

Abstract

The aim of the study was to evaluate outcome of children after severe traumatic brain injury treated according to intracranial pressure (ICP)-targeted protocol, to define threshold values of peak ICP and minimal cerebral perfusion pressure (CPP) for decompressive osteoplastic craniotomy, and to determine the relationship between ICP, CPP and long-term outcome in these children. All children admitted to Pediatric Intensive Care Unit of Kaunas University of Medicine Hospital after severe head injury from January 2004 to June 2006 and treated according to ICP-targeted protocol for the management of severe head trauma were prospectively included in the study. Raised ICP was defined as a level higher than 20 mmHg. Minimal CPP was considered to be at a level of 40 mmHg. Outcome was defined using Glasgow Outcome Scale (GOS) at discharge from the hospital and after 6 months. Forty-eight patients (32 boys and 16 girls) were included into the study. Favorable outcome (GOS score of 4 and 5) after 6 months was achieved in 43 (89.6%) cases. Mean peak ICP was 24.2+/-7.2 mmHg and mean minimal CPP - 53.1+/-14.7 mmHg. Decompressive craniotomy was performed in 13 cases. Threshold values of peak ICP and minimal CPP for decompressive craniotomy were 22.5 mmHg (area under the curve, 0.880) and 46.5 mmHg (area under the curve, 0.898), respectively. The differences in peak ICP and minimal CPP in groups of favorable and unfavorable outcomes were not statistically significant. Treating children after severe traumatic brain injury according to the ICP-targeted protocol for the management of severe pediatric traumatic brain injury resulted in a favorable long-term outcome.

Highlights

Traumatic brain injury (TBI) causes significant morbidity and mortality in children [1]
There is a lack of data on optimal cerebral perfusion pressure (CPP) and intracranial pressure (ICP) targets for pediatric TBI [9]
The aim of the study was to evaluate outcome of children after severe traumatic brain injury treated according to ICP-targeted protocol of the management of severe pediatric TBI, to define threshold values of Correspondence to D

Summary

Introduction

Traumatic brain injury (TBI) causes significant morbidity and mortality in children [1]. In contrast to adult practice, severe traumatic brain injury is more commonly isolated injury in children [2]. In patients with severe TBI, mortality is usually caused by an untreatable increase in intracranial pressure (ICP) [5]. Children are more likely to suffer increased intracranial pressure and diffuse cerebral injury than adults who tend to develop focal intracranial lesions. Management of severe TBI in the intensive care unit (ICU) is largely focused on the management of raised intracranial pressure and preservation of cerebral perfusion [1, 6,7,8]. There is a lack of data on optimal cerebral perfusion pressure (CPP) and ICP targets for pediatric TBI [9]

Objectives

Methods

Results

Conclusion