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，初始脑损伤后的低血压有助于继发性脑损伤和脑卒中的结局。改变的脑生理学，包括受损的脑自动调节和充血，也可能有助于儿童TBI后的不良结局。因此，表征最佳的脑血流动力学立即严重小儿TBI是很重要的。本研究的目的是描述严重儿童TBI后脑血流动力学与预后之间的关系。这里提出的具体目标将提供关于严重TBI儿童的早期脑血流动力学管理的新信息。目的是检查（1）脑灌注压与结果之间的关系，（2）脑自动调节持续受损与结果之间的关系，以及（3）与年龄相关的充血发生率。研究者还将检查充血和受损的脑自动调节之间的关系，以及持续充血和严重儿童TBI后结果之间的关系。在不同年龄的儿童中进行这些研究很重要，因为（1）发育期间脑血流动力学变化显著，（2）与年龄较大的儿童相比，严重TBI后的最佳脑血流动力学在幼儿中可能不同，（3）儿童的生理数据缺乏，（4）儿科实践目前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的研究脑血流动力学的儿童在脑缺血的风险，无论有没有TBI。这项拟议中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.