Continuous monitoring of cerebrovascular pressure reactivity after traumatic brain injury in children.

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  • Additional Information
    • Source:
      Publisher: American Academy of Pediatrics Country of Publication: United States NLM ID: 0376422 Publication Model: Print Cited Medium: Internet ISSN: 1098-4275 (Electronic) Linking ISSN: 00314005 NLM ISO Abbreviation: Pediatrics Subsets: MEDLINE
    • Publication Information:
      Publication: Elk Grove Village Il : American Academy of Pediatrics
      Original Publication: Springfield, Ill., Thomas.
    • Subject Terms:
      Cerebrospinal Fluid Pressure* ; Monitoring, Physiologic*; Blood Pressure/*physiology ; Brain Injuries/*diagnosis ; Intracranial Pressure/*physiology; Adolescent ; Brain Injuries/mortality ; Brain Injuries/physiopathology ; Child ; Child, Preschool ; Cohort Studies ; Coma/diagnosis ; Coma/mortality ; Coma/physiopathology ; Female ; Glasgow Coma Scale ; Homeostasis/physiology ; Hospital Mortality ; Humans ; Infant ; Male ; Pilot Projects ; Prognosis
    • Abstract:
      Objective: We hypothesized that pressure reactivity index (PRx) values indicating preserved cerebrovascular pressure autoregulation would be associated with survival in children with traumatic brain injury (TBI). This hypothesis was tested in a prospective, blinded, observational, pilot study.
      Methods: Twenty-one children admitted between May 2006 and September 2008 with severe TBI necessitating invasive intracranial pressure monitoring were enrolled in this study. The PRx was continuously monitored as a moving, linear correlation coefficient between low-frequency waves of intracranial and arterial blood pressures. Positive values of PRx approaching 1 indicate impaired cerebrovascular pressure reactivity, whereas negative PRx values or values close to 0 indicate preserved cerebrovascular pressure reactivity. Survival was the primary outcome and was compared with the average PRx value obtained during the intracranial pressure-monitoring period.
      Results: PRx was associated with survival in this cohort; survivors (N = 15) had a mean PRx +/- SD of 0.08 +/- 0.19, and nonsurvivors (N = 6) had a mean PRx of 0.69 +/- 0.21 (P = .0009). In this sample, continuous PRx monitoring suggested impaired cerebrovascular pressure reactivity at low levels of cerebral perfusion pressure (CPP) and intact cerebrovascular pressure reactivity at higher levels of CPP.
      Conclusions: Intact cerebrovascular pressure reactivity quantified with the PRx is associated with survival after severe head trauma in children. The PRx is CPP dependent in children. The PRx may be useful for defining age-specific and possibly patient-specific optimal targets for CPP after TBI.
    • Grant Information:
      G0001237 United Kingdom MRC_ Medical Research Council; G0600986 United Kingdom MRC_ Medical Research Council; G9439390 United Kingdom MRC_ Medical Research Council
    • Publication Date:
      Date Created: 20091202 Date Completed: 20091230 Latest Revision: 20220223
    • Publication Date:
      20231215
    • Accession Number:
      10.1542/peds.2009-0550
    • Accession Number:
      19948619