Continuous Monitoring of Cerebrovascular Pressure Reactivity After Traumatic Brain Injury in Children
Continuous Monitoring of Cerebrovascular Pressure Reactivity After Traumatic Brain Injury in Children
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DOI：
10.1542/peds.2009-0550
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发表时间：
2009-12-01
期刊：
影响因子：
8
通讯作者：
Guerguerian, Anne-Marie
中科院分区：
文献类型：
--
作者：
Brady, Ken M.;Shaffner, Donald H.;Guerguerian, Anne-Marie
目的：我们假设，压力反应性指数（PRx）值表明保留脑血管压力自动调节与创伤性脑损伤（TBI）儿童的生存率相关。这一假设进行了测试，在前瞻性，盲法，观察，pilot study.METHODS：21名儿童在2006年5月和2008年9月之间承认严重TBI需要侵入性颅内压监测被纳入本研究。连续监测PRx作为颅内和动脉血压低频波之间的移动线性相关系数。接近1的PRx正值表示脑血管压力反应性受损，而PRx负值或接近0的值表示脑血管压力反应性保留。生存率是主要结果，并与颅内压监测期间获得的平均PRx值进行比较。结果：PRx与该队列的生存率相关;存活者（N = 15）的平均PRx +/- SD为0.08 +/- 0.19，而非存活者（N = 6）的平均PRx为0.69 +/- 0.21（P = 0.0009）。在这个样本中，连续PRx监测表明受损的脑血管压力反应性在低水平的脑灌注压（CPP）和完整的脑血管压力反应性在较高水平的CPP.CONCLUSIONS：完整的脑血管压力反应性定量与PRx与严重的头部创伤后的儿童生存。PRx在儿童中依赖CPP。PRx可能有助于确定TBI后CPP的年龄特异性和可能的患者特异性最佳靶点。儿科2009; 124：e1205-e1212
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. Pediatrics 2009; 124: e1205-e1212