OBJECT: The authors evaluated the initial intracranial pressure (ICP) and cerebral perfusion pressure (CPP) as prognostic factors in severe head injury in children and tried to determine the optimal CPP range. METHODS: The authors performed a 9-year retrospective review of all patients with severe traumatic brain injuries (TBIs) who required invasive ICP monitoring and were admitted to the pediatric intensive care unit at their institution between January 1995 and December 2003. These patients had Glasgow Coma Scale scores lower than 8 and/or required ICP monitoring due to worsening neurological status or neuroimaging results suggestive of cerebral hypertension. Clinical summaries and imaging studies were reviewed. Data for 156 pediatric patients who ranged in age from 1 to 18 years were obtained. Half of these patients presented with normal initial ICPs (< 20 mm Hg), and a good outcome was achieved in 80% of these children. An unfavorable outcome was observed in more than 60% of patients with an initial CPP lower than 40 mm Hg. The proportion of patients with an unfavorable outcome decreased to 10% with initial CPPs higher than 60 mm Hg, but patients with initial CPPs higher than 70 mm Hg did not improve. CONCLUSIONS: Initial ICP and CPP measurements were useful as prognostic factors in pediatric patients with severe TBIs: patients with initial CPPs between 40 and 70 mm Hg were found to have a better neurological prognosis than those with CPPs either higher or lower than that range.
OBJECT: The authors evaluated the initial intracranial pressure (ICP) and cerebral perfusion pressure (CPP) as prognostic factors in severe head injury in children and tried to determine the optimal CPP range. METHODS: The authors performed a 9-year retrospective review of all patients with severe traumatic brain injuries (TBIs) who required invasive ICP monitoring and were admitted to the pediatric intensive care unit at their institution between January 1995 and December 2003. These patients had Glasgow Coma Scale scores lower than 8 and/or required ICP monitoring due to worsening neurological status or neuroimaging results suggestive of cerebral hypertension. Clinical summaries and imaging studies were reviewed. Data for 156 pediatric patients who ranged in age from 1 to 18 years were obtained. Half of these patients presented with normal initial ICPs (< 20 mm Hg), and a good outcome was achieved in 80% of these children. An unfavorable outcome was observed in more than 60% of patients with an initial CPP lower than 40 mm Hg. The proportion of patients with an unfavorable outcome decreased to 10% with initial CPPs higher than 60 mm Hg, but patients with initial CPPs higher than 70 mm Hg did not improve. CONCLUSIONS: Initial ICP and CPP measurements were useful as prognostic factors in pediatric patients with severe TBIs: patients with initial CPPs between 40 and 70 mm Hg were found to have a better neurological prognosis than those with CPPs either higher or lower than that range.
Authors: Victor Curvello; Hugh Hekierski; Philip Pastor; Monica S Vavilala; William M Armstead Journal: Brain Res Date: 2017-06-15 Impact factor: 3.252
Authors: Jane L Di Gennaro; Christopher D Mack; Amin Malakouti; Jerry J Zimmerman; William Armstead; Monica S Vavilala Journal: Dev Neurosci Date: 2010-12-02 Impact factor: 2.984
Authors: Bernd Walter; Kristina Aisenpreis; Harald G Fritz; Jens Soukup; Michael Eiselt; Reinhard Bauer Journal: Intensive Care Med Date: 2010-03-16 Impact factor: 17.440
Authors: Baxter B Allen; Ya-Lin Chiu; Linda M Gerber; Jamshid Ghajar; Jeffrey P Greenfield Journal: Pediatr Crit Care Med Date: 2014-01 Impact factor: 3.624