Hemodynamics and Outcome in Pediatric Brain Injury

描述（由申请人提供）：创伤性脑损伤（TBI）是一岁以上儿童死亡的主要原因。有证据表明，初次脑损伤后低血压会导致继发性脑损伤，并使预后恶化。脑生理学改变，包括脑自身调节受损和充血也可能导致儿童TBI后预后不良。因此，在严重儿童创伤性脑损伤后立即确定最佳脑血流动力学特征是很重要的。本研究的目的是描述严重儿童创伤性脑损伤后脑血流动力学与预后的关系。本文提出的具体目的将为严重TBI患儿的早期脑血流动力学治疗提供新的信息。目的是检查(1)脑灌注压与预后之间的关系，(2)脑自动调节的持续损害与预后之间的关系，以及(3)充血的年龄相关发生率。研究人员还将研究充血与大脑自身调节受损之间的关系，以及严重儿童TBI后持续充血与预后之间的关系。在不同年龄的儿童中进行这些研究是很重要的，因为(1)大脑血流动力学在发育过程中会发生显著变化，(2)严重创伤性脑损伤后的最佳脑血流动力学在幼儿中可能与大龄儿童不同，(3)缺乏儿童生理学数据，(4)儿科实践目前是从成人实践中推断出来的。在这项研究中获得的结果和经验将有助于未来研究脑缺血风险儿童的脑血流动力学，无论是有或没有创伤性脑损伤。拟议的研究将在华盛顿大学进行，该大学以指导患者为导向的研究而闻名。

DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) is the leading cause of mortality in children over one year of age. Evidence suggests that hypotension after initial brain injury contributes to secondary brain injury and worsens outcome. Altered cerebral physiology including impaired cerebral autoregulation and hyperemia may also contribute to poor outcome following pediatric TBI. Therefore, characterizing optimal cerebral hemodynamics immediately following severe pediatric TBI is important. The objective of the proposed research is to describe the relationship between cerebral hemodynamics following severe pediatric TBI and outcome. The specific aims proposed here will provide new information regarding the early cerebral hemodynamic management of children with severe TBI. The aims are to examine (1) the relationship between cerebral perfusion pressure and outcome, (2) the relationship between persistent impairment of cerebral autoregulation and outcome, and (3) the age-related incidence of hyperemia. The investigators will also examine the relationship between hyperemia and impaired cerebral autoregulation and the relationship between persistent hyperemia and outcome following severe pediatric TBI. It is important to conduct these studies in children of various ages because (1) cerebral hemodynamics change significantly during development, (2) optimal cerebral hemodynamics following severe TBI may differ in young children compared to older children, (3) there is a paucity of physiologic data in children, and (4) pediatric practice is currently extrapolated from adult practice. The results and experience gained in this research will aid in the future study of cerebral hemodynamics in children at risk of cerebral ischemia both with and without TBI. The proposed research will be carried out at the University of Washington, well-known known for mentored patient-oriented research.