Pediatric Critical Care Medicine:

May 2014 - Volume 15 - Issue 4_suppl - p 68

doi: 10.1097/01.pcc.0000449016.28883.4c

MULTI-MODAL MONITORING FOR BRAIN INJURY IN CRITICALLY ILL CHILDREN

Agrawal, S.; Varsos, G.V.; Liu, X.; Smielewski, P.; Czosnyka, M.

ABSTRACT

Background and aims: Multi-modal monitoring (MMM) has been used to manage traumatic brain injury (TBI) in adults; however, there is limited experience in paediatrics. MMM is used to derive real time optimum cerebral perfusion pressure (CPPopt) at which the cerebral autoregulation is the best by monitoring cerebrovascular reactivity defined by pressure reactivity index (PRx) [derived from slow wave variations in arterial blood pressure (ABP) and intracranial pressure (ICP)].

Aims: We present our experience of using MMM in Paediatric intensive care unit (PICU).

Methods: In a group of 7 severe TBI and 1 encephalitis patients, MMM was conducted including ICP, ABP, CPP, heart rate (HR), ventilator parameters, pulse oximetry (SPaO2) supported by dedicated software (ICM+; www.neurosurg.cam.ac.uk/icmplus). We additionally evaluated PRx and CPPopt.

Results: 1. In non-survivors, ICP was significantly higher (37 + 30 mm Hg versus 13.1+ 2.9 mm Hg; p<0.05). 2. Non-survivors had prolonged periods of deteriorating PRx (PRx >0.3, coded with colour line, so called solid-red line). Overall mean PRx in these patients was worse (survivors PRx=0.06; non-survivors=0.32; p=0.18). 3. Non-survivors had a tendency to lower mean CPP than CPPopt (CPP-CPPopt: 1.5 mm Hg vs -14 mm Hg; p=0.10). 4. CPPopt varied from 60 to 80 mm Hg in this group of patients. This indicates that fixed therapeutic threshold for CPP may not be applicable to all TBI patients treated with age appropriate CPP.

Conclusions: Additional data needs to be collected before any further conclusions can be drawn.