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Acta Neurochirurgica

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01-11-2017 | Original Article - Brain Injury

Time spent with impaired autoregulation is linked with outcome in severe infant/paediatric traumatic brain injury

Authors: Konstantin Hockel, Jennifer Diedler, Felix Neunhoeffer, Ellen Heimberg, Carmen Nagel, Martin U. Schuhmann

Published in: Acta Neurochirurgica | Issue 11/2017

Abstract

Background

It could be shown in traumatic brain injury (TBI) in adults that the functional status of cerebrovascular autoregulation (AR), determined by the pressure reactivity index (PRx), correlates to and even predicts outcome. We investigated PRx, cerebral perfusion pressure (CPP) and intracranial pressure (ICP) and their correlation to outcome in severe infant and paediatric TBI.

Methods

Seventeen patients (range, 1 day to 14 years) with severe TBI (median GCS at presentation, 4) underwent long-term computerised ICP and mean arterial pressure (MAP) monitoring using dedicated software to determine CPP and PRx and optimal CPP (CPP level where PRx shows best autoregulation) continuously. Outcome was determined at discharge and at follow-up using the Glasgow Outcome Scale.

Results

Favourable outcome was reached in eight patients, unfavourable outcome in seven patients. Two patients died. Nine patients underwent decompressive craniectomy to control ICP during Intensive Care Unit treatment. When dichotomised to outcome, no significant difference was found for overall ICP, CPP and PRx. The time with severely impaired AR (PRx >0.2) was significantly longer for patients with unfavourable outcome (64 h vs 6 h, p = 0.001). Continuously impaired AR of ≥24 h and age <1 year was associated to unfavourable outcome. Children with favourable outcome spent the entire monitoring time at or above the optimal CPP.

Conclusions

Integrity of AR has a similar role for outcome after TBI in the paediatric population as in adults. The amount of time spent with deranged AR seems to be associated with outcome; a factor especially critical for infant patients. The results of this preliminary study need to be validated in the future.

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Title: Time spent with impaired autoregulation is linked with outcome in severe infant/paediatric traumatic brain injury
Authors: Konstantin Hockel
Jennifer Diedler
Felix Neunhoeffer
Ellen Heimberg
Carmen Nagel
Martin U. Schuhmann
Publication date: 01-11-2017
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 11/2017
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-017-3308-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Time spent with impaired autoregulation is linked with outcome in severe infant/paediatric traumatic brain injury

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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