Time spent with impaired autoregulation is linked with outcome in severe infant/paediatric traumatic brain injury
Time spent with impaired autoregulation is linked with outcome in severe infant/paediatric traumatic brain injury
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DOI：
10.1007/s00701-017-3308-8
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发表时间：
2017-11-01
影响因子：
2.4
通讯作者：
Schuhmann, Martin U.
中科院分区：
文献类型：
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作者：
Hockel, Konstantin;Diedler, Jennifer;Schuhmann, Martin U.
在成人创伤性脑损伤（TBI）中，由压力反应性指数（PRx）确定的脑血管自动调节（AR）的功能状态与结果相关，甚至可预测结果。我们研究了PRx、脑灌注压（CPP）和颅内压（ICP）及其与严重婴儿和儿科TBI结局的相关性。（范围：1天至14岁）（就诊时GCS中位数，4）使用专用软件进行长期计算机化ICP和平均动脉压（MAP）监测，以确定CPP和PRx以及最佳CPP（CPP水平，PRx显示最佳自动调节）。结果在出院和随访时使用格拉斯哥结果量表确定，8例患者达到有利结果，7例患者达到不利结果。两名患者死亡。9例患者在重症监护室治疗期间接受去骨瓣减压术以控制ICP。当对结局进行二分时，未发现总体ICP、CPP和PRx的显著差异。对于预后不良的患者，AR严重受损（PRx > 0.2）的时间显著延长（64 h vs 6 h，p = 0.001）。AR持续受损24小时和年龄< 1岁与不良结局相关。结果良好的儿童在整个监测时间内处于或高于最佳CPP。AR的完整性对儿科人群TBI后的结果具有与成人相似的作用。与精神错乱的AR一起度过的时间似乎与结果相关;这是一个对婴儿患者尤其重要的因素。这项初步研究的结果需要在今后得到验证。
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.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.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.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.