Hemodynamic and intracranial pressure changes in children with severe traumatic brain injury.

Abstract: Objectives: To evaluate the predictability of intracranial pressure (ICP), cerebral perfusion pressure (CPP) and hemodynamic monitoring for outcome of children with severe traumatic brain injury (TBI). Patients and methods: The study included 53 children with severe TBI. All the patients were immediately admitted to Neurosurgical Intensive Care Unit (NICU) for determination of baseline data and to receive first aid management and assessment of head injury severity according to post-resuscitation Glasgow coma scale (GCS) and patients were enrolled if they had GCS of ⩽8. All the patients had insertion of the intraventicular ICP sensor either at the end of surgery if indicated or through Kocher’s pathway and were maintained for a maximum of 5days. All the patients had non-invasive monitoring for heart rate (HR), blood pressure measures and CPP. Glasgow outcome scale (GOS) was determined at discharge time and 6months thereafter. Results: Thirty-seven patients continued their ICU stay and were discharged alive for a survival rate of 75.8% and 28 of survivors (75.7%) had favorable outcome. Hemodynamic parameters estimated at the time of catheter removal showed significant changes in survivors compared to their levels estimated at the time of catheter insertion and to non-survivors. Patients having favorable outcome showed more stable hemodynamic changes, while those who had unfavorable outcome showed autonomic instability manifested as significantly lower SBP, DBP and MAP with non-significantly lower ICP and CPP. Statistical analysis defined CPP as the highly significant predictor of outcome with CPP as the significant predictor for survival and favorable outcome. Analysis of the variability of estimated hemodynamic parameters, as predictors for survival defined disturbed ICP as the significant sensitive predictor and disturbed SBP as a significant predictor. Conclusion: Hemodynamic stability for children had TBI mandatory for improvement of their outcome with high and low CPP with concomitant large range of SBP variability which could be considered as predictors for bad outcome. [Copyright &y& Elsevier]