The effect of hypotension and hypoxia on children with severe head injuries

Pigula, Frank A.; Wald, Steven L.; Shackford, Steven R.; Vane, Dennis W.

doi:10.1016/0022-3468(93)90223-8

Cited by 326 publications

(144 citation statements)

References 14 publications

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“…It has been well documented that hypotensive episodes can be deleterious in severe TBI [32,33,34]. Although hypotensive agents are used in the Lund concept, episodes of hypotension (defined as SAP below 70 mmHg+2 age) were detected in only 0.5% of observations.…”

Section: Discussionmentioning

confidence: 99%

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Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

et al. 2005

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Objective: This study evaluated the outcome of treatment according to the Lund concept in children with severe traumatic brain injury and investigated whether the preset goals of the protocol were achieved. Design and setting: A twocenter retrospective study in neurointensive care units at university hospitals. Patients: Forty-one children with severe traumatic brain injury from blunt trauma and arriving at hospital within 24 h after injury. Median age was 8.8 years (range 3 months-14.2 years), Glasgow Coma Scale 7 (3-8), and Injury Severity Score 25 (16-75). All children had pathological findings on initial computed tomography. All developed intracranial hypertension, and survivors required intensive care longer than 72 h. Interventions: Treatment according to the principles of the Lund concept. Measurements and results: Neurosurgery was required in 46% of the children. Survival rate was 93% and favorable outcome (Glasgow Outcome Score 4 or 5) was 80% at long-term follow-up (median 12 months postinjury, range 2.5-26). The preset physiological and biochemical goals were achieved in over 90% of observations. Conclusions: Treating pediatric patients with severe traumatic brain injury, according to the Lund concept, results in a favorable outcome when the protocol is followed.

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Section: Discussionmentioning

confidence: 99%

“…Large prospective randomized clinical trails are essential to compare the efficacy of different strategies [32,37,38,39,40]. These are not easy to perform in children with severe TBI since the number of children treated at each center is low.…”

Section: Discussionmentioning

confidence: 99%

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

et al. 2005

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“…Beyond these limits of autoregulation, CBF depends on MAP/CPP; hypotension results in cerebral ischemia, and hypertension causes cerebral hyperemia. Hypotension after pediatric TBI is associated with poor outcome [10][11][12].…”

Section: Cerebral Autoregulationmentioning

confidence: 99%

“…Secondary insults, representing discrete events that may be monitored for and intervened upon, are predictable, potentially avoidable, and include systemic causes such as hypotension [93,94], hypocarbia, hypercarbia [78,79,95], hypoxia [11,96], hyperthermia [97], and hyperglycemia [98,99]. These insults result in secondary injuries which signify underlying neurological processes related to cellular and molecular mechanisms of injury/ death, including inflammatory responses, impairment of cerebral autoregulation, excitotoxicity, delayed cell death, and BBB breakdown [92].…”

Section: Secondary Insults and Injuriesmentioning

confidence: 99%

“…Trauma accounts for 36% of deaths in U.S. children 1-14 years of age [4], and traumatic brain injury (TBI) is the leading cause of pediatric trauma [5]. Low Glasgow Coma Scale score, coagulopathy, hyperglycemia, early hypotension, and impaired cerebral autoregulation are associated with poor outcome after pediatric TBI [6][7][8][9][10][11][12]. In this review, we discuss what we know about CBF and cerebral autoregulation in children with and without TBI.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Udomphorn

Armstead

Vavilala

2008

Pediatric Neurology

133

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Traumatic brain injury is a global health concern and is the leading cause of traumatic morbidity and mortality in children. Despite a lower overall mortality than in adult traumatic brain injury, the cost to society from the sequelae of pediatric traumatic brain injury is very high. Predictors of poor outcome after traumatic brain injury include altered systemic and cerebral physiology, including altered cerebral hemodynamics. Cerebral autoregulation is often impaired following traumatic brain injury and may adversely impact poor outcome. Although altered cerebrovascular hemodynamics early after traumatic brain injury may contribute to disability in children, there is a paucity of information regarding changes in cerebral blood flow and cerebral autoregulation after pediatric traumatic brain injury. In this article, we discuss normal pediatric cerebral physiology and cerebrovascular pathophysiology following pediatric traumatic brain injury.

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Hypotension, Hypoxia, and Head Injury

Manley¹

2001

Arch Surg

439

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The effect of hypotension and hypoxia on children with severe head injuries

Cited by 326 publications

References 14 publications

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept

Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Hypotension, Hypoxia, and Head Injury

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