Prognostic value of arterial blood gas disturbances for in-hospital mortality in pediatric patients with severe traumatic brain injury

Rahimi, Sepide; Bidabadi, Elham; Mashouf, Mehryar; Saadat, Seyed Mohammad Seyed; Rahimi, Samane

doi:10.1007/s00701-013-1929-0

Cited by 13 publications

(14 citation statements)

References 28 publications

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“…Chiaretti et al [24] reported that post traumatic hypoxia and hypotension are associated with poor outcome. However, there are also studies in which hypoxia is not seen as a factor that statistically affects poor prognosis [25,26].…”

Section: Discussionmentioning

confidence: 99%

The Relationship of Blood Gas Values With Prognosis in Pediatric Patients With Severe Head Trauma

Kayabas

Şahin

2021

Preprint

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Purpose:Severe head traumas in the childhood age group has an important place in terms of mortality and morbidity among all traumas. Our aim in this study is to consider the relationship between the severity of severe head trauma and arterial blood gas (ABG) parameter levels in children.Methods:In our study, patients with head trauma, intubation and Glascow Coma Score (GCS) ≤ 8 were retrospectively analyzed. Showing homogeneous distribution; Independent sample T test was used for pH, PCO2 and base extract (BE) parameters, and Mann Whitney U test was used for PO2 and lactate parameters not showing homogeneous distribution. ROC analysis was done.Results:Of the 48 patients included in the study, 17 died while lying in the intensive care unit. There was no statistical difference when looking at the relationship between age, gender, surgical methods and mortality of the patients (p> 0.05). The relationship of patients with acidosis, hypercapnia and hyperlactatemia in ABG with mortality was statistically significant (p˂0.05). No statistically significant difference was found between surviving and deceased in ABG of patients regarding BE and hypoxia (p= 0.075; 0.175). there was a statistically significant difference between the mean values of PCO2 and lactate which are among the quantitative values and those who survived and died (p <0.05).Conclusion: Acidosis, the presence hypercapnia and hyperlactatemia were found to be associated with mortality in children with severe head trauma in ABG analysis. This study shows that PCO2 and lactate levels in ABG can be a biomarker in determining the prognosis in pediatric patients with traumatic brain injury (TBI).

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Section: Discussionmentioning

confidence: 99%

The Relationship of Blood Gas Values With Prognosis in Pediatric Patients With Severe Head Trauma

Kayabas

Şahin

2021

Preprint

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“…However, the interactions between the respiratory system and intracranial hemodynamic in brain-injured patients are more complex, and the ventilatory management is challenging. Children with severe TBI could present initial mixed metabolic acidosis plus respiratory acidosis [ 6 ] , and it is advocated the early correction of hypoxemia avoiding hypocarbia. In this scenario, the use of PEEP could improve oxygenation, but it could affect intracranial pressure.…”

Section: Discussionmentioning

confidence: 99%

“…A steep rise of pressure can affect cerebral blood flow, while secondary insults can arise from systemic factors, hypoxemia and hypotension [ 5 ]. The initial mixed metabolic acidosis plus respiratory acidosis and Glasgow Coma Scale Score (GCS) are significant predictors of mortality [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of positive end expiratory pressure on cerebral hemodynamic in paediatric patients with post-traumatic brain swelling treated by surgical decompression

et al. 2018

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IntroductionThe objective of our present study is to evaluate the impact of different PEEP levels on cerebral hemodynamic, gas exchanges and respiratory system mechanics in paediatric patients with post-traumatic brain swelling treated with decompressive craniectomy (DC).Materials and methodsA prospective physiologic study was carried out on 14 paediatric patients presenting with severe traumatic brain swelling treated with DC. Transcranial Doppler ultrasonography was performed on the middle cerebral artery bilaterally after DC. After assessment at ZEEP, intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial pressure (MAP), central venous pressure (CVP) and gas exchanges were recorded at PEEP 4 and PEEP 8.ResultsFrom ZEEP to PEEP 8, the compliance of respiratory system indexed to the weight of the patient significantly increased (P = 0.02) without ICP modifications. No significant variation of the MAP, CPP, Vmed, the total resistance of respiratory system and ohmic resistance of the respiratory system indexed to the weight of the patients was observed. CVP significantly increased between ZEEP and PEEP 8 (P = 0.005), and between PEEP 4 and PEEP 8 (P = 0.05).ConclusionsPEEP values up to 8 cmH20 seem to be safe in paediatric patients with a severe post-traumatic brain swelling treated with DC.

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“…One previous study found that initial mixed metabolic and respiratory acidosis was a significant predictor for mortality in children with severe TBI. 9 Other investigators have demonstrated that initial base deficit and lactate levels were independent prognostic factors of mortality in severe pediatric trauma patients but little is known about the utility of these values in cases of pediatric TBI. [10][11][12][13] The main aim of this study is to correlate arterial blood gas (ABG) markers and lactate levels with outcomes in children with TBI.…”

Section: Introductionmentioning

confidence: 99%

Correlation of arterial blood gas markers and lactate levels with outcomes in pediatric traumatic brain injury

Hong

Chong

et al. 2017

Proceedings of Singapore Healthcare

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Background: Various physical markers have been used to predict outcome of traumatic brain injury in children. However, the utility of metabolic alterations for prognostication has been poorly described. Thus, we aim to correlate arterial blood gas markers and lactate levels with outcomes in children with moderate to severe traumatic brain injury. Methods: This is a retrospective cohort study that included all patients <16 years old who presented to the Emergency Department with moderate to severe traumatic brain injury (Glasgow Coma Scale ⩽13). Serial arterial blood gas results and lactate levels in the first five days of admission to a pediatric intensive care unit (PICU) were reviewed. Primary outcome was in-hospital mortality. Secondary outcomes were 28-day ventilator-free and PICU-free days. A stepwise logistic regression analysis in conjunction with receiver operating characteristic analysis were used to identify variables that were associated with in-hospital mortality. Secondary outcomes were analyzed using multiple linear regression. Results: Among the 43 patients analyzed, more than half of the patients (60%) had severe traumatic brain injury (Glasgow Coma Scale 8). Twenty-seven of the 43 (65%) patients underwent neurosurgical intervention and overall mortality was 9/43 (20.9%). The worst base excess and lactate levels of Day 2 of PICU stay were found to be most predictive for mortality with maximal area-under-curve (95% confidence interval) of 0.967 (0.906, 1.000). Worst lactate level on day 2 of PICU stay was also found to be associated with ventilator-free days and PICU-free days. Conclusion: In children with moderate to severe traumatic brain injury, base excess and lactate on Day 2 of PICU stay were predictors of mortality, duration of mechanical ventilation and length of PICU stay.

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Prognostic value of arterial blood gas disturbances for in-hospital mortality in pediatric patients with severe traumatic brain injury

Cited by 13 publications

References 28 publications

The Relationship of Blood Gas Values With Prognosis in Pediatric Patients With Severe Head Trauma

The Relationship of Blood Gas Values With Prognosis in Pediatric Patients With Severe Head Trauma

Impact of positive end expiratory pressure on cerebral hemodynamic in paediatric patients with post-traumatic brain swelling treated by surgical decompression

Correlation of arterial blood gas markers and lactate levels with outcomes in pediatric traumatic brain injury

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