Citation

Stippler M, Ortiz V, Adelson PD, Chang YF, Tyler-Kabara EC, Wisniewski SR, Fink EL, Kochanek PM, Brown SD, Bell MJ. J. Neurosurg. Pediatr. 2012; 10(5): 383-391.

Affiliation

Departments of Neurological Surgery.

Copyright

(Copyright © 2012, American Association of Neurological Surgeons)

DOI

10.3171/2012.8.PEDS12165

PMID

22978637

Abstract

Object Minimizing secondary brain injuries after traumatic brain injury (TBI) in children is critical to maximizing neurological outcome. Brain tissue oxygenation monitoring (as measured by interstitial partial pressure of O(2) [PbO(2)]) is a new tool that may aid in guiding therapies, yet experience in children is limited. This study aims to describe the authors' experience of PbO(2) monitoring after TBI. It was hypothesized that PbO(2) thresholds could be established that were associated with favorable neurological outcome, and it was determined whether any relationships between PbO(2) and other important clinical variables existed. Methods Forty-six children with severe TBI (Glasgow Coma Scale score ≤ 8 after resuscitation) who underwent PbO(2) and brain temperature monitoring between September 2004 and June 2008 were studied. All patients received standard neurocritical care, and 24 were concurrently enrolled in a trial of therapeutic early hypothermia (n = 12/group). The PbO(2) was measured in the uninjured frontal cortex. Hourly recordings and calculated daily means of various variables including PbO(2), intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial blood pressure, partial pressure of arterial O(2), and fraction of inspired O(2) were compared using several statistical approaches. Glasgow Outcome Scale scores were determined at 6 months after injury. Results The mean patient age was 9.4 years (range 0.1-16.5 years; 13 girls) and 8554 hours of monitoring were analyzed (PbO(2) range 0.0-97.2 mm Hg). A PbO(2) of 30 mm Hg was associated with the highest sensitivity/specificity for favorable neurological outcome at 6 months after TBI, yet CPP was the only factor that was independently associated with favorable outcome. Surprisingly, instances of preserved PbO(2) with altered ICP and CPP were observed in some children with unfavorable outcomes. Conclusions Monitoring of PbO(2) demonstrated complex interactions with clinical variables reflecting intracranial dynamics using this protocol. A higher threshold than reported in studies in adults was suggested as a potential therapeutic target, but this threshold was not associated with improved outcomes. Additional studies to assess the utility of PbO(2) monitoring after TBI in children are needed.

Language: en