Relationship of Cerebral Perfusion Pressure and Survival in Pediatric Brain-Injured Patients

Downard, Cynthia D.; Hulka, Frieda; Mullins, Richard J.; Piatt, Joseph H.; Chesnut, Randall M.; Quint, P.; Mann, N. Clay; Ramenofsky, Max L.; Vane, Dennis W.

doi:10.1097/00005373-200010000-00012

Cited by 161 publications

(83 citation statements)

References 11 publications

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“…While previous studies have separately described the relationship between ED and PICU hypotension on outcome, none serially compared the relative importance of the early period to the PICU period in the same population. Studies examining the relationship between PICU hypotension and poor outcome did not consider field and/or ED hypotension in their analysis (13,14). Our finding that field hypotension predicted ED hypotension may reflect the fact that therapeutic regimens to maintain or restore hemodynamics can be limited in the field.…”

Section: Discussionmentioning

confidence: 80%

Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury*

Coates¹,

Vavilala²,

Mack³

et al. 2005

Critical Care Medicine

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Objective-To examine the influence of definition and location (field, emergency department [ED] or Pediatric Intensive Care Unit [PICU]) of hypotension on outcome following severe pediatric Traumatic Brain Injury (TBI). Participants-93 children < 14 years of age with TBI following injury, head abbreviated injury score (AIS) ≥ 3, and PICU admission Glasgow Coma Sale (GCS) score < 9 formed the analytic sample. Data sources included the Harborview Trauma Registry and Hospital Records. Design-Retrospective Cohort study. Setting-HarborviewOutcome Measures-The relationship between hypotension and outcome was examined comparing two definitions of hypotension: 1) systolic blood pressure (SBP) < 5 th percentile for age and 2) SBP < 90 mmHg. Hospital discharge Glasgow Outcome score (GOS) < 4, or disposition of either death or discharge to a skilled nursing facility were considered poor outcomes. PICU and hospital length of stay (LOS) were also examined.Results-SBP < 5 th percentile for age was more highly associated with poor hospital discharge GOS (p = 0.001), poor disposition (p = 0.02), PICU LOS (RR 9.5; 95% CI 6.7-12.3) and hospital LOS (RR 18.8;) than SBP < 90mmHg. Hypotension occurring in either the field or ED, but not in the PICU, was associated with poor GOS (p = 0.008), poor disposition (p= 0.03) and hospital LOS (RR 18.7; 95% CI 13.1-24.2).Conclusions-Early hypotension, defined as SBP < 5 th percentile for age in the field and/or ED, was a better predictor of poor outcome than delayed hypotension or the use of SBP < 90 mmHg.

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Section: Discussionmentioning

confidence: 80%

Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury*

Coates¹,

Vavilala²,

Mack³

et al. 2005

Critical Care Medicine

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“…based on ICP (19,20), and the avoidance of systemic hypotension was primarily responsible for this improved outcome (21,22). Taken together, these findings suggest that maintenance of adequate CPP, primarily by manipulating MAP, would prevent cerebral ischemia, attenuate the brain damage and improve the prognosis even though ICP remains elevated in bacterial meningitis.…”

Section: Introductionmentioning

confidence: 94%

Effects of Dopamine Infusion on Cerebral Blood Flow, Brain Cell Membrane Function and Energy Metabolism in ExperimentalEscherichia coliMeningitis in the Newborn Piglet

et al. 2003

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In the present study, we tested whether maintenance of adequate cerebral perfusion pressure (CPP) by pharmacologically preventing systemic hypotension with dopamine infusion would prevent cerebral ischemia and attenuate energy depletion and neuronal injury even though intracranial pressure remains elevated in a newborn piglet meningitis model. Cerebral blood flow, measured at the end of the experiment using fluorescent microspheres, was significantly increased by dopamine infusion. The decreased cerebral cortical cell membrane Na+, K+ -ATPase activity and increased lipid peroxidation products, indicative of meningitis-induced brain damage, were significantly attenuated by dopamine infusion. Dopamine also significantly attenuated the meningitis-induced reduction in both brain ATP and phosphocreatine levels and the increase in brain lactate level. In summary, maintenance of adequate CPP with dopamine prevented cerebral ischemia, reduced cerebral energy depletion, and attenuated brain injury in neonatal bacterial meningitis.

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“…7,8 Monitoring ICP and aggressive treatment for IH have also been associated with better outcomes in the literature about pediatric patients with severe head injuries. 9,10 However, pediatric guidelines recommend monitoring ICP in children and teenagers with severe head injuries in cases of class III evidence, uncertain level of clinical safety or therapeutic option.…”

Section: Introductionmentioning

confidence: 99%

Fatores associados à hipertensão intracraniana em crianças e adolescentes vítimas de traumatismo crânio-encefálico grave

Guerra

Carvalho

Affonseca

et al. 2010

J. Pediatr. (Rio J.)

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Objective: To analyze factors associated with intracranial hypertension in pediatric patients who suffered severe head injuries. Methods:Retrospective cohort study, with data collected from September 1998 through August 2003, including patients aged 0 to 16 who suffered severe head injuries, Glasgow score < 9, and submitted to intracranial pressure (ICP) monitoring (n = 132). Intracranial hypertension (IH) was defined as an episode of ICP > 20 mmHg requiring treatment, while refractory IH was ICP over 25 mmHg requiring barbiturates or decompressive craniectomy. Univariate analysis was followed by multivariate analysis; variables were considered significant if p < 0.05. Results:Ages ranged from 2 months to 16 years, median age 9.7 (6.0-2.3) years. Glasgow scores ranged from 3 to 8, median 6 (4-7). Traffic accidents were responsible for 79.5% of events. Monitoring devices were installed, on average, 14 hours after trauma, median time 24 hours. One hundred and three patients (78%) had IH, while 57 (43.2%) had refractory IH. In multivariate analysis, younger age ranges were associated with IH [relative risk = 1.67 (1.03-2.72); p = 0.037], and abnormal postures were associated with refractory IH [relative risk = 2.25 (1.06-4.78)]. The group mortality rate was 51.5%; it was correlated with use of barbiturates in refractory IH and low cerebral perfusion pressure at the intensive care unit.Conclusions: IH and refractory IH were frequent events in pediatric patients who suffered severe head injuries. The younger the patient, the greater the chance of developing IH. The presence of abnormal postures was found to be a risk factor for refractory IH. No conflicts of interest declared concerning the publication of this article.Suggested citation: Guerra SD, Carvalho LF, Affonseca CA, Ferreira AR, Freire HB. Factors associated with intracranial hypertension in children and teenagers who suffered severe head injuries. J Pediatr (Rio J). 2010;86(1):73-79.

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Relationship of Cerebral Perfusion Pressure and Survival in Pediatric Brain-Injured Patients

Abstract: Low mean CPP was lethal. In children with survivable brain injury (mean CPP > 40 mm Hg), CPP did not stratify patients for risk of adverse outcome.

Cited by 161 publications

References 11 publications

Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury*

Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury*

Effects of Dopamine Infusion on Cerebral Blood Flow, Brain Cell Membrane Function and Energy Metabolism in ExperimentalEscherichia coliMeningitis in the Newborn Piglet

Fatores associados à hipertensão intracraniana em crianças e adolescentes vítimas de traumatismo crânio-encefálico grave

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