Mean Arterial Pressure and Discharge Outcomes in Severe Pediatric Traumatic Brain Injury.
Mean Arterial Pressure and Discharge Outcomes in Severe Pediatric Traumatic Brain Injury.
复制标题
严重儿童创伤性脑损伤的平均动脉压和出院结局。
DOI：
10.1007/s12028-020-01121-z
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发表时间：
2021-06
影响因子：
3.5
通讯作者：
Vavilala MS
中科院分区：
文献类型：
--
作者：
Erickson SL;Killien EY;Wainwright M;Mills B;Vavilala MS
优化血压是儿童创伤性脑损伤（TBI）后干预的重要目标。现有文献研究了收缩压（SBP）与预后之间的关系。平均动脉压（MAP）是一种比收缩压更好的器官灌注测量方法，用于确定脑灌注压，但以前尚未研究过与儿童TBI后预后的关系。我们的目的是评估入院后早期基于map的低血压与出院结果之间的关联强度，并比较基于map和基于sbp的血压百分位数之间低血压与预后的相对关联强度。我们研究了存活至少12小时的严重（格拉斯哥昏迷量表评分<9）TBI儿童在儿童重症监护病房入院后12小时内最低年龄特异性MAP百分比与出院预后不良（院内死亡或转至熟练护理机构）之间的关系。泊松回归结果根据最大头部简易损伤量表（AIS）严重程度评分、最大非头部AIS和血管活性药物使用情况进行调整。我们还检查了前12小时内最低MAP百分位数预测出院结果的能力，使用未调整协变量的受试者工作曲线特征分析。我们对比了MAP和收缩压百分位数之间的预测能力和血压与预后相关的相对强度。对166名年龄<18岁儿童的资料进行了检查，其中20.4%的儿童出院预后较差。较差的出院结果在最低MAP <第5百分位（42.9%;aRR 5.3 vs. 50 -94百分位，95% CI 1.2, 23.0）和MAP第5 -9百分位（40%;aRR 8.5, 95% CI 1.9, 38.7）的患者中最为常见。在不考虑损伤严重程度或血管活性药物使用的情况下，最低MAP百分位数可中度预测出院预后不良（AUC:0.75, 95% CI 0.66, 0.85）。相比之下，最低收缩压仅在<5百分位数（50%;aRR 5.4, 95% CI 1.3, 22.2）与不良出院预后相关。最低收缩压百分位数可中度预测不良出院预后（AUC: 0.82, 95% CI 0.74, 0.91）。在严重TBI患儿中，儿科重症监护病房入院后的前12小时内，单个MAP <10百分位数与出院预后不良相关。前12小时最低的MAP百分位数可中度预测出院预后不良。最低MAP百分位数与预后的相关性高于最低收缩压百分位数，但其预测能力略低于收缩压。
Optimizing blood pressure is an important target for intervention following pediatric traumatic brain injury (TBI). Existing literature has examined the association between systolic blood pressure (SBP) and outcomes. Mean arterial pressure (MAP) is a better measure of organ perfusion than SBP and is used to determine cerebral perfusion pressure but has not been previously examined in relation to outcomes after pediatric TBI. We aimed to evaluate the strength of association between MAP-based hypotension early after hospital admission and discharge outcome, and to contrast the relative strength of association of hypotension with outcome between MAP-based and SBP-based blood pressure percentiles. We examined the association between lowest age-specific MAP percentile within 12 hours after pediatric intensive care unit admission and poor discharge outcome (in-hospital death or transfer to a skilled nursing facility) in children with severe (Glasgow Coma Scale score <9) TBI who survived at least 12 hours. Poisson regression results were adjusted for maximum head Abbreviated Injury Scale (AIS) severity score, maximum non-head AIS, and vasoactive medication use. We also examined the ability of lowest MAP percentile during the first 12 hours to predict discharge outcomes using receiver operating curve characteristic analysis without adjustment for covariates. We contrasted the predictive ability and the relative strength of association of blood pressure with outcome between MAP and SBP percentiles. Data from 166 children age <18 years were examined, of whom 20.4% had a poor discharge outcome. Poor discharge outcome was most common among patients with lowest MAP <5th percentile (42.9%; aRR 5.3 vs. 50th-94th percentile, 95% CI 1.2, 23.0) and MAP 5th-9th percentile (40%; aRR 8.5, 95% CI 1.9, 38.7). Without adjustment for injury severity or vasoactive medication use, lowest MAP percentile was moderately predictive of poor discharge outcome (AUC:0.75, 95% CI 0.66, 0.85). In contrast, lowest SBP was associated with poor discharge outcome only for the <5th percentile (50%; aRR 5.4, 95% CI 1.3, 22.2). Lowest SBP percentile was moderately predictive of poor discharge outcome (AUC: 0.82, 95% CI 0.74, 0.91). In children with severe TBI, a single MAP <10th percentile during the first 12 hours after Pediatric Intensive Care Unit admission was associated with poor discharge outcome. Lowest MAP percentile during the first 12 hours was moderately predictive of poor discharge outcome. Lowest MAP percentile was more strongly associated with outcome than lowest SBP percentile but had slightly lower predictive ability than SBP.
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影响因子：
4.1
作者：
Haque, Ikram U.;Zaritsky, Arno L.
通讯作者：
Zaritsky, Arno L.
影响因子：
2.4
作者：
Kokoska, ER;Smith, GS;Weber, TR
通讯作者：
Weber, TR
影响因子：
36.4
作者：
Vavilala, Monica S.;King, Mary A.;Johnston, Brian D.
通讯作者：
Johnston, Brian D.
影响因子：
8.8
作者：
Lehman LW;Saeed M;Talmor D;Mark R;Malhotra A
通讯作者：
Malhotra A
影响因子：
4.2
作者：
Chaiwat, Onuma;Sharma, Deepak;Vavilala, Monica S.
通讯作者：
Vavilala, Monica S.