Does adherence to treatment targets in children with severe traumatic brain injury avoid brain hypoxia? A brain tissue oxygenation study

被引:44
作者
Figaji, Anthony A. [1 ]
Fieggen, A. Graham
Argent, Andrew C. [2 ]
LeRoux, Peter D. [3 ]
Peter, Jonathan C.
机构
[1] Univ Cape Town, Red Cross Childrens Hosp, Div Neurosurg, Sch Child & Adolescent Hlth,Inst Child Hlth 617, ZA-7700 Rondebosch, South Africa
[2] Univ Cape Town, Red Cross Childrens Hosp, Sch Child & Adolescent Hlth, Div Pediat Crit Care, ZA-7700 Rondebosch, South Africa
[3] Hosp Univ Penn, Dept Neurosurg, Philadelphia, PA 19104 USA
关键词
brain hypoxia; cerebral ischemia; cerebral oxygenation; cerebral perfusion pressure; children; head injury; traumatic brain injury;
D O I
10.1227/01.NEU.0000335074.39728.00
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE: Most physicians rely on conventional treatment targets for intracranial pressure, cerebral perfusion pressure, systemic oxygenation, and hemoglobin to direct management of traumatic brain injury (TBI) in children. In this study, we used brain tissue oxygen tension (PbtO(2)) monitoring to examine the association between PbtO(2) values and Outcome in pediatric severe TBI and to determine the incidence of compromised PbtO(2) in patients for whom acceptable treatment targets had been achieved. METHODS: In this prospective observational study, 26 children with severe TBI and a median postresuscitation Glasgow Coma Scale score of 5 were managed with continuous PbtO(2) monitoring. The relationships between outcome and the 6-hour period of lowest PbtO(2) values and the length of time that PbtO(2) was less than 20, 15, 10, and 5 mmHg were examined. The incidence of reduced PbtO(2) for each threshold was evaluated where the following targets were met: intracranial pressure less than 20 mmHg, cerebral perfusion pressure greater than 50 mmHg, arterial oxygen tension greater than 60 mmHg (and peripheral oxygen saturation > 90%), and hemoglobin greater than 8 g/dl. RESULTS:There was a significant association between poor outcome and the 6-hour period of lowest PbtO(2) and length of time that PbtO(2) was less than 15 and 10 mmHg. Multiple logistic regression analysis showed that low PbtO(2) had an independent association with poor outcome. Despite achieving the management targets described above, 80% of patients experienced one or more episodes of compromised PbtO(2) (< 20 mmHg), and almost one-third experienced episodes of brain hypoxia (PbtO(2) < 10 mmHg). CONCLUSION: Reduced PbtO(2) is associated with poor outcome in pediatric severe TBI. In addition, many patients experience episodes of compromised PbtO(2) despite achieving acceptable treatment targets.
引用
收藏
页码:83 / 91
页数:9
相关论文
共 55 条
[1]  
Adelson P David, 2003, Pediatr Crit Care Med, V4, pS31
[2]  
Adelson P David, 2003, Pediatr Crit Care Med, V4, pS2, DOI 10.1097/01.CCM.0000066600.71233.01
[3]  
Adelson P David, 2003, Pediatr Crit Care Med, V4, pS12
[4]  
[Anonymous], J NEUROTRAUMA
[5]  
Arias Elizabeth, 2003, Natl Vital Stat Rep, V52, P1
[6]   Intracranial pressure and cerebral perfusion pressure as risk factors in children with traumatic brain injuries [J].
Catala-Temprano, Albert ;
Claret Teruel, Gemma ;
Cambra Lasaosa, Francisco Jose ;
Pons Odena, Marti ;
Noguera Julian, Antoni ;
Palomeque Rico, Antonio .
JOURNAL OF NEUROSURGERY, 2007, 106 (06) :463-466
[7]  
CDC National Center for Injury Prevention and Control, WEB BAS INJ STAT QUE
[8]   Critical thresholds of intracranial pressure and cerebral perfusion pressure related to age in paediatric head injury [J].
Chambers, IR ;
Jones, PA ;
Lo, TYM ;
Forsyth, RJ ;
Fulton, B ;
Andrews, PJD ;
Mendelow, AD ;
Minns, RA .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2006, 77 (02) :234-240
[9]   Determination of threshold levels of cerebral perfusion pressure and intracranial pressure in severe head injury by using receiver-operating characteristic curves: an observational study in 291 patients [J].
Chambers, IR ;
Treadwell, L ;
Mendelow, AD .
JOURNAL OF NEUROSURGERY, 2001, 94 (03) :412-416
[10]   The impact of initial management on the outcome of children with severe head injury [J].
Chiaretti, A ;
De Benedictis, R ;
Della Corte, F ;
Piastra, M ;
Viola, L ;
Polidori, G ;
Di Rocco, C .
CHILDS NERVOUS SYSTEM, 2002, 18 (1-2) :54-60