Quantification of secondary CPP insult severity in paediatric head injured patients using a pressure-time index

Jones, Patricia A.; Chambers, I. R.; Lo, T.Y.M.; Andrews, Peter; Chaudhry, W.; Clark, Alexander; Croft, James; Forsyth, Rob; Fulton, Benjamin L.; Mendelow, A. D.; Wilson, GabrielH.; Minns, R. A.

doi:10.1007/3-211-32318-x_7

Cited by 10 publications

(9 citation statements)

References 5 publications

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“…23,46 These methods were also validated in a study in the pediatric population, in which the ICP AUC was correlated with mortality, and the cumulative pressure-time index for below-threshold CPP was correlated with outcome morbidity and mortality. 22,50 Therefore, the measurement of daily and cumulative ICP burdens is a meaningful outcome variable.…”

Section: Cumulative Icp Reductionmentioning

confidence: 99%

Hypertonic saline reduces cumulative and daily intracranial pressure burdens after severe traumatic brain injury

Mangat

Chiu²,

Gerber

et al. 2015

JNS

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ObJect Increased intracranial pressure (ICP) in patients with traumatic brain injury (TBI) is associated with a higher mortality rate and poor outcome. Mannitol and hypertonic saline (HTS) have both been used to treat high ICP, but it is unclear which one is more effective. Here, the authors compare the effect of mannitol versus HTS on lowering the cumulative and daily ICP burdens after severe TBI. MetHODS The Brain Trauma Foundation TBI-trac New York State database was used for this retrospective study. Patients with severe TBI and intracranial hypertension who received only 1 type of hyperosmotic agent, mannitol or HTS, were included. Patients in the 2 groups were individually matched for Glasgow Coma Scale score (GCS), pupillary reactivity, craniotomy, occurrence of hypotension on Day 1, and the day of ICP monitor insertion. Patients with missing or erroneous data were excluded. Cumulative and daily ICP burdens were used as primary outcome measures. The cumulative ICP burden was defined as the total number of days with an ICP of > 25 mm Hg, expressed as a percentage of the total number of days of ICP monitoring. The daily ICP burden was calculated as the mean daily duration of an ICP of > 25 mm Hg, expressed as the number of hours per day. The numbers of intensive care unit (ICU) days, numbers of days with ICP monitoring, and 2-week mortality rates were also compared between the groups. A 2-sample t-test or chisquare test was used to compare independent samples. The Wilcoxon signed-rank or Cochran-Mantel-Haenszel test was used for comparing matched samples. reSultS A total of 35 patients who received only HTS and 477 who received only mannitol after severe TBI were identified. Eight patients in the HTS group were excluded because of erroneous or missing data, and 2 other patients did not have matches in the mannitol group. The remaining 25 patients were matched 1:1. Twenty-four patients received 3% HTS, and 1 received 23.4% HTS as bolus therapy. All 25 patients in the mannitol group received 20% mannitol. The mean cumulative ICP burden (15.52% [HTS] vs 36.5% [mannitol]; p = 0.003) and the mean (± SD) daily ICP burden (0.3 ± 0.6 hours/day [HTS] vs 1.3 ± 1.3 hours/day [mannitol]; p = 0.001) were significantly lower in the HTS group. The mean (± SD) number of ICU days was significantly lower in the HTS group than in the mannitol group (8.5 ± 2.1 vs 9.8 ± 0.6, respectively; p = 0.004), whereas there was no difference in the numbers of days of ICP monitoring (p = 0.09). There were no significant differences between the cumulative median doses of HTS and mannitol (p = 0.19). The 2-week mortality rate was lower in the HTS group, but the difference was not statistically significant (p = 0.56). cONcluSiONS HTS given as bolus therapy was more effective than mannitol in lowering the cumulative and daily ICP burdens after severe TBI. Patients in the HTS group had significantly lower number of ICU days. The 2-week mortality rates were not statistically different between the 2 groups.http://thejns.org/doi/abs/10.3171/2014....

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Section: Cumulative Icp Reductionmentioning

confidence: 99%

Hypertonic saline reduces cumulative and daily intracranial pressure burdens after severe traumatic brain injury

Mangat

Chiu²,

Gerber

et al. 2015

JNS

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“…For example, Kokoska et al (1998) described an association between poor outcome and the number of hypotensive episodes (SBP values of Ͻ5 th percentile for age and gender) during the first 24 h after injury, but the data were not analyzed by hours after injury. Subsequently, Jones et al (2005) reported that hypotension burden (high hypotension intensity and frequency) in the pediatric intensive care unit (PICU) was associated with poor outcome, but early (field and emergency department) data were often missing and data collection began at different times after PICU admission. More recently, Ducrocq et al (2006) reported a 31% incidence of hypotension, defined as a 15% lower mean arterial pressure compared to age norms, on arrival to hospital, and an association between hypotension and poor 6-month outcome.…”

Section: Introductionmentioning

confidence: 99%

“…Coates et al (2005) suggested that discharge outcomes may be worse in children when hypotension occurred both in the field or emergency department (ED) compared to hypotension occurring later in the PICU, but the number of patients with both field and ED hypotension was small and the data were analyzed by location of hypotension rather than time after TBI. Collectively, hypotension definitions and SBP data collection start times after pediatric TBI in all these published studies have varied (Pigula et al, 1993;Kokoska et al, 1998;Chiaretti et al, 2002;Vavilala et al, 2003;Coates et al, 2005;Jones et al, 2005;Hackbarth et al, 2002;Downard et al, 2000), making it difficult to determine the relative importance of early versus late hypotension.…”

Section: Introductionmentioning

confidence: 99%

Time of Hypotension and Discharge Outcome in Children with Severe Traumatic Brain Injury

Samant

Mack

Rivara

et al. 2008

Journal of Neurotrauma

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We performed a retrospective study at a level I pediatric trauma center of patients admitted between 1998 and 2005 to determine the time after severe pediatric traumatic brain injury (TBI) that hypotension (systolic blood pressure [SBP] of <5th percentile) is most strongly associated with poor outcome. One hundred forty-six patients of <18 years of age with TBI, head Abbreviated Injury Score (AIS) of >or=3, and PICU admission Glasgow Coma Scale (GCS) score of <9 formed the analytic sample. Available SBP readings through the first 72 h after severe TBI were collected. SBP of <5th percentile was defined as hypotension. Discharge Glasgow Outcome Scale (GOS) score of <4 defined poor outcome. Of 146, 59 (40%) patients had discharge GOS of <4 and 12% died. The adjusted risk of poor outcome associated with hypotension stabilized by 8 h (adjusted risk ratio [RR] 1.7; 95% confidence interval [CI] 1.1-2.6) after injury. The risk of poor outcome peaked with hypotension occurring within the first 6 h after injury (RR 2.0, 95% CI 1.3-3.3). Poor discharge GOS was predicted by hypotension occurring during the first 6 h after injury. SBP data beyond the first 6 h did not improve our ability to predict poor discharge GOS. The first 6 h after severe pediatric TBI may represent a critical time period for either predicting or improving outcome.

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“…Untreated rises in intracranial pressure, falls in blood pressure, or both will cause a reduction in cerebral perfusion pressure. Low cerebral perfusion pressure is also associated with unfavorable outcome in children with traumatic brain injury [17,18]. We hypothesize that the episodes of hypotension and low cerebral perfusion pressure led to a higher risk of unfavorable outcome in patients treated with hypothermia therapy in our trial.…”

Section: Discussionmentioning

confidence: 91%

Impact of Hypotension and Low Cerebral Perfusion Pressure on Outcomes in Children Treated with Hypothermia Therapy following Severe Traumatic Brain Injury: A post hoc Analysis of the Hypothermia Pediatric Head Injury Trial

Hutchison

Frndova²,

Lo³

et al. 2010

Dev Neurosci

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Hypotension and low cerebral perfusion pressure are known to be associated with unfavorable outcome in children and adults with traumatic brain injury. Using the database from a previously published, randomized controlled trial of 24 h of hypothermia therapy in children with severe traumatic brain injury, we compared the number of patients with hypotension or low cerebral perfusion pressure between the hypothermia therapy and normothermia groups. We also determined the association between these physiologic insults and unfavorable outcome using regression analysis. There were more patients with episodes of hypotension or low cerebral perfusion pressure in the hypothermia therapy group than in the normothermia group. These physiologic insults were associated with unfavorable outcome in both intervention groups. Hypotension and low cerebral perfusion pressure should be anticipated and prevented in future trials of hypothermia therapy in patients with traumatic brain injury.

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Quantification of secondary CPP insult severity in paediatric head injured patients using a pressure-time index

Cited by 10 publications

References 5 publications

Hypertonic saline reduces cumulative and daily intracranial pressure burdens after severe traumatic brain injury

Hypertonic saline reduces cumulative and daily intracranial pressure burdens after severe traumatic brain injury

Time of Hypotension and Discharge Outcome in Children with Severe Traumatic Brain Injury

Impact of Hypotension and Low Cerebral Perfusion Pressure on Outcomes in Children Treated with Hypothermia Therapy following Severe Traumatic Brain Injury: A post hoc Analysis of the Hypothermia Pediatric Head Injury Trial

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