Background: In patients who die from head injury, ischaemic damage is noted in >90% of cases. Prevention of hypoxic-ischaemic brain insult following children's head injury is best achieved by measures such as pressors or mannitol, aimed at reducing the principal cause of secondary brain insult, namely impaired CPP.
Purpose: To describe a proŞle of CPP insults in terms of their definition, frequency, duration, and amplitude, and define a cumulative pressure-time index (PTI) to reflect the total burden of brain CPP insult after TBI.
Methods: This prospective, physiologically based study of 81 head-injured children (2-15 years) admitted to PICU, used patient monitored BP, ICP and CPP time-series data extracted from bedside monitors. For each patient, the total numbers of episodes, durations, and mean amplitudes of insults were calculated, along with a novel PTI which was developed and applied. Outcome was assessed at 6 months post-injury.
Results: 80% of children had recorded CPP insults. 11 children died, 5 were severely and 23 moderately disabled, and 26 made a good recovery. A total of 1255 CPP insult-episodes were found (mean 19/patient) and was not related to outcome. The cumulative CPP insult lasted for 56,713 min, and was individually related to outcome (P<0.001). The mean duration of each patient insult-episode was 82 min (range 7-1041), also related to outcome categories (P<0.001). The PTI was defined as
∑ (CPPthreshold - CPPvalue) X tsampleinterval/60
and was signifcantly associated with modifed GOS categories (e.g. independent vs. poor) (P<0.001). The contours of the individual CPP insults were investigated to determine whether a prolonged low amplitude derangement was more deleterious for outcome than a short duration-high amplitude insult.
Conclusions: The profile of typical CPP insults is described following TBI in children with its implication for neuroprotective homeostatic strategies of management.
Jones P, Chambers I, Minns R. Characterisation of cerebral perfusion pressure (CPP) insults following children's head injury. European Journal of Paediatric Neurology (2005) 9, 181-299.
Dr. Iain R. Chambers, Cleveland Unit, Middlesbrough. Tel: +44 (0)1642-854-778.
Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK.
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