Citation

Velle F, Lewén A, Howells T, Enblad P, Nilsson P. J. Neurosurg. Pediatr. 2019; ePub(ePub): ePub.

Copyright

(Copyright © 2019, American Association of Neurological Surgeons)

DOI

10.3171/2019.10.PEDS19268

PMID

31881539

Abstract

OBJECTIVE: Refractory intracranial pressure (ICP) hypertension following traumatic brain injury (TBI) is a severe condition that requires potentially harmful treatment strategies such as barbiturate coma. However, the use of barbiturates may be restricted due to concerns about inducing multiorgan system complications related to the therapy. The purpose of this study was to evaluate the outcome and occurrence of treatment-related complications to barbiturate coma treatment in children with refractory intracranial hypertension (RICH) due to TBI in a modern multimodality neurointensive care unit (NICU).

METHODS: The authors conducted a retrospective cohort study of 21 children ≤ 16 years old who were treated in their NICU between 2005 and 2015 with barbiturate coma for RICH following TBI. Demographic and clinical data were acquired from patient records and physiological data from digital monitoring system files.

RESULTS: The median age of these 21 children was 14 years (range 2-16 years) and at admission the median Glasgow Coma Scale score was 7 (range 4-8). Barbiturate coma treatment was added due to RICH at a median of 46 hours from trauma and had a median duration of 107 hours. The onset of barbiturate coma resulted in lower ICP values, lower pulse amplitudes on the ICP curve, and decreased amount of A-waves. No major disturbances in blood gases, liver and kidney function, or secondary insults were observed during this period. Outcome 1 year later revealed a median Glasgow Outcome Scale score of 5 (good recovery), however on the King's Outcome Scale for Childhood Head Injury, the median was 4a (moderate disability).

CONCLUSIONS: The results of this study indicate that barbiturate coma, when used in a modern NICU, is an effective means of lowering ICP without causing concomitant severe side effects in children with RICH and was compatible with good long-term outcome.

Language: en

Keywords

CPP = cerebral perfusion pressure; CVP = central venous pressure; EVD = external ventricular drain; GCS = Glasgow Coma Scale; GMT = good monitoring time; GOS = Glasgow Outcome Scale; ICP = intracranial pressure; KOSCHI = King’s Outcome Scale for Childhood Head Injury; MAP = mean arterial pressure; MVO = motor vehicle occupant; NICU = neurointensive care unit; RICH = refractory intracranial hypertension; TBI = traumatic brain injury; barbiturate coma; outcome; pCO2 = partial pressure of carbon dioxide; refractory intracranial hypertension; trauma; traumatic brain injury