Visualizing the pressure and time burden of intracranial hypertension in adult and paediatric traumatic brain injury
Visualizing the pressure and time burden of intracranial hypertension in adult and paediatric traumatic brain injury
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DOI：
10.1007/s00134-015-3806-1
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发表时间：
2015-06-01
影响因子：
38.9
通讯作者：
Meyfroidt, Geert
中科院分区：
文献类型：
--
作者：
Guiza, Fabian;Depreitere, Bart;Meyfroidt, Geert
评估颅内压升高发作的持续时间和强度对成人和儿童外伤性脑损伤6个月神经预后的影响。对来自欧洲多个中心的261名成人和99名儿童外伤性脑损伤患者的分分钟颅内压和平均动脉血压数据进行前瞻性分析。颅内压升高发作（定义为在一定时间内高于一定阈值的压力）与6个月格拉斯哥结果量表的关系用颜色编码的图显示。颜色编码的图说明了一个直观的概念，即高颅内压发作只能耐受较短的持续时间：描述与较差结果相关的那些颅内压发作的持续时间和强度的曲线是一条近似指数衰减曲线。在儿童中，曲线与成人相似，但在颅内压阈值较低的情况下，发作与预后较差有关。成人颅内压高于20mmhg持续时间超过37分钟，儿童颅内压超过8分钟，与较差的预后相关。在一个多变量模型中，连同已知的严重外伤性脑损伤预后的基线危险因素，累积颅内压-时间负担与死亡率独立相关。当用低频自调节指数评估的脑血管自调节受损时，耐受颅内压升高的能力降低。当脑灌注压低于50mmhg时，所有颅内压损伤，无论持续时间长短，均与较差的预后相关。与较差预后相关的颅内压-时间负荷在彩色编码图中显示。与成人相比，儿童继发性损伤发生在较低的颅内压阈值。受损的脑血管自身调节降低了对颅内压损伤的耐受能力。因此，50 mmHg可能是脑灌注压可接受的较低阈值。
To assess the impact of the duration and intensity of episodes of increased intracranial pressure on 6-month neurological outcome in adult and paediatric traumatic brain injury.Analysis of prospectively collected minute-by-minute intracranial pressure and mean arterial blood pressure data of 261 adult and 99 paediatric traumatic brain injury patients from multiple European centres. The relationship of episodes of elevated intracranial pressure (defined as a pressure above a certain threshold during a certain time) with 6-month Glasgow Outcome Scale was visualized in a colour-coded plot.The colour-coded plot illustrates the intuitive concept that episodes of higher intracranial pressure can only be tolerated for shorter durations: the curve that delineates the duration and intensity of those intracranial pressure episodes associated with worse outcome is an approximately exponential decay curve. In children, the curve resembles that of adults, but the delineation between episodes associated with worse outcome occurs at lower intracranial pressure thresholds. Intracranial pressures above 20 mmHg lasting longer than 37 min in adults, and longer than 8 min in children, are associated with worse outcomes. In a multivariate model, together with known baseline risk factors for outcome in severe traumatic brain injury, the cumulative intracranial pressure-time burden is independently associated with mortality. When cerebrovascular autoregulation, assessed with the low-frequency autoregulation index, is impaired, the ability to tolerate elevated intracranial pressures is reduced. When the cerebral perfusion pressure is below 50 mmHg, all intracranial pressure insults, regardless of duration, are associated with worse outcome.The intracranial pressure-time burden associated with worse outcome is visualised in a colour-coded plot. In children, secondary injury occurs at lower intracranial pressure thresholds as compared to adults. Impaired cerebrovascular autoregulation reduces the ability to tolerate intracranial pressure insults. Thus, 50 mmHg might be the lower acceptable threshold for cerebral perfusion pressure.