ICP, PRx, CPP, and ∆CPPopt in pediatric traumatic brain injury: the combined effect of insult intensity and duration on outcome.
ICP, PRx, CPP, and ∆CPPopt in pediatric traumatic brain injury: the combined effect of insult intensity and duration on outcome.
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DOI：
10.1007/s00381-023-05982-5
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发表时间：
2023-09
影响因子：
1.4
通讯作者：
Enblad, Per
中科院分区：
文献类型：
--
作者：
Wettervik, Teodor Svedung;Velle, Fartein;Hanell, Anders;Howells, Timothy;Nilsson, Pelle;Lewen, Anders;Enblad, Per
目的是调查颅内压 (ICP)、压力反应性指数 (PRx)、脑灌注压 (CPP) 和最佳 CPP (CPPopt) 等损伤强度和持续时间对儿童创伤性脑损伤 (TBI) 临床结果的综合影响。这项观察性研究纳入了 61 名患有严重 TBI 的儿科患者，这些患者于 2007 年至 2018 年间在乌普萨拉大学医院接受治疗，在受伤后前 10 天至少有 12 小时的 ICP 数据。 ICP、PRx、CPP 和 ΔCPPopt（实际 CPP-CPPopt）损伤被可视化为二维图，以说明损伤强度和持续时间对神经恢复的综合影响。该队列主要是青少年儿童 TBI 患者，中位年龄为 15 岁（四分位距 12-16）岁。对于 ICP，高于 25 mmHg 的短暂发作（分钟）和 ICP 20-25 mmHg 稍长的发作（20 分钟）与不良结果相关。对于 PRx，短暂高于 0.25 的值以及较长时间（30 分钟）内稍低的值（大约 0）均与不良结果相关。对于 CPP，当 CPP 低于 50 mmHg 时，结果会从有利结果转变为不利结果。高 CPP 与结果之间没有关联。对于 ΔCPPopt，当 ΔCPPopt 低于 -10 mmHg 时，结果从有利结果转变为不利结果。未发现 ΔCPPopt 正值与结果之间存在关联。这种可视化方法说明了损伤强度和持续时间与严重儿科 TBI 结局相关的综合影响，支持了之前避免长时间发作高 ICP 和低 CPP 的观点。此外，较长时间发作的较高 PRx 和低于 CPPopt 超过 -10 mmHg 的 CPP 与较差的结果相关，表明以自我调节为导向的管理在儿科 TBI 中的潜在作用。
The aim was to investigate the combined effect of insult intensity and duration, regarding intracranial pressure (ICP), pressure reactivity index (PRx), cerebral perfusion pressure (CPP), and optimal CPP (CPPopt), on clinical outcome in pediatric traumatic brain injury (TBI). This observational study included 61 pediatric patients with severe TBI, treated at the Uppsala University Hospital, between 2007 and 2018, with at least 12 h of ICP data the first 10 days post-injury. ICP, PRx, CPP, and ∆CPPopt (actual CPP-CPPopt) insults were visualized as 2-dimensional plots to illustrate the combined effect of insult intensity and duration on neurological recovery. This cohort was mostly adolescent pediatric TBI patients with a median age at 15 (interquartile range 12–16) years. For ICP, brief episodes (minutes) above 25 mmHg and slightly longer episodes (20 min) of ICP 20–25 mmHg correlated with unfavorable outcome. For PRx, brief episodes above 0.25 as well as slightly lower values (around 0) for longer periods of time (30 min) were associated with unfavorable outcome. For CPP, there was a transition from favorable to unfavorable outcome for CPP below 50 mmHg. There was no association between high CPP and outcome. For ∆CPPopt, there was a transition from favorable to unfavorable outcome when ∆CPPopt went below −10 mmHg. No association was found for positive ∆CPPopt values and outcome. This visualization method illustrated the combined effect of insult intensity and duration in relation to outcome in severe pediatric TBI, supporting previous notions to avoid high ICP and low CPP for longer episodes of time. In addition, higher PRx for longer episodes of time and CPP below CPPopt more than −10 mmHg were associated with worse outcome, indicating a potential role for autoregulatory-oriented management in pediatric TBI.
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