The objective of this report is to describe cerebral autoregulation after severe inflicted pediatric traumatic brain injury (iTBI). We examined cerebral autoregulation of both cerebral hemispheres (mean autoregulatory index; ARI) in children <5 years with Glasgow Coma Scale (GCS) score of <9 and no evidence of brain death within the first 48 h of pediatric intensive care unit (PICU) admission. Discharge and 6-month Glasgow Outcome Scale (GOS) scores were collected. GOS of <4 reflected poor outcome. All three iTBI and all seven noninflicted TBI (nTBI) patients had admission GCS score of <9. Eight of 10 patients had Autoregulatory Index (ARI) of <0.4 (impaired cerebral autoregulation) of at least one hemisphere. All children with iTBI had poor outcome, and none had intact cerebral autoregulation in both hemispheres. Children with nTBI had better overall outcome than those with iTBI. Two of the children with nTBI had intact autoregulation in both hemispheres and good outcome. Two of the three children with iTBI had differential effects on autoregulation between hemispheres despite bilateral injury. These are, to our knowledge, the first data on cerebral blood flow autoregulation in the unique setting of iTBI and provide a rationale for further study of their relationship to outcome and effects of therapy.

Cerebral autoregulation often changed and worsened during the first 9 days after severe pediatric TBI. Worsening cerebral autoregulation may mirror worsening TBI.

BackgroundSimulation is widely used in airway management training.ObjectivesTo show that assigning anesthesia residents’ simulation educator roles improved cognitive learning outcomes.MethodsPostgraduate second- and third-year (PGY-2 and PGY-3) anesthesia residents were randomly assigned to three groups: a teacher group (T), a hot-seat (active participant) group (H), and an observer group (O). After a train-the-trainer session, the T group prepared simulation scenarios for difficult airway management and then conducted the simulation sessions and post-session debriefing. The H group participated in the scenarios, and the O group observed the sessions. All participants attended the post-session debriefing. Evaluation was conducted at pretest, immediate posttest, and 3 months (retention test). Score differentiation and average normalized gain were calculated. Participants completed a post-simulation class survey.ResultsParticipants were 49 residents (PGY-2 = 24, PGY-3 = 25). The T group had the highest posttest score (17.06 ± 1.23); this score significantly differed from the O group (14.75 ± 2.57, P = 0.003) but not the H group (15.64 ± 1.54, P = 0.103). The average normalized gain was significantly higher in the T group than in the H and O groups (0.51 ± 0.22, 0.18 ± 0.32, and 0.17 ± 0.47, respectively; P = 0.012). Participants retained knowledge at 3 months after the session, with no significant differences among the groups. Most participants (45%) preferred to be active scenario participants, and 20% preferred to teach. Overall satisfaction was high in all groups.ConclusionThis study showed that a teaching role can be effectively applied for residents in simulation-based education on difficult airway management to support better learning outcomes.

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