Hemodynamics and Outcome in Pediatric Brain Injury

描述(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，最初脑损伤后的低血压会导致继发性脑损伤，并恶化预后。脑生理改变，包括脑自我调节功能受损和充血，也可能是儿童脑外伤后不良预后的原因。因此，在儿童重型颅脑损伤后立即确定最佳的脑血流动力学是重要的。本研究的目的是描述儿童严重脑外伤后脑血流动力学与预后的关系。这里提出的具体目标将为重型颅脑损伤儿童的早期脑血流动力学管理提供新的信息。目的是研究(1)脑灌流压与预后的关系，(2)持续性脑自我调节障碍与预后的关系，以及(3)与年龄相关的充血发生率。研究人员还将研究充血和脑自我调节受损之间的关系，以及持续性充血和儿童严重脑外伤后预后的关系。在不同年龄段的儿童中进行这些研究是很重要的，因为(1)脑血流动力学在发育过程中发生显著变化，(2)严重脑外伤后的最佳脑血流动力学在幼儿中可能与年龄较大的儿童不同，(3)儿童缺乏生理学数据，以及(4)目前儿科实践是从成人实践中推断出来的。这项研究的结果和经验将有助于未来研究脑缺血危险儿童的脑血流动力学，包括合并和不合并脑损伤。这项拟议的研究将在华盛顿大学进行，该大学以指导以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.