Continuous Multimodality Monitoring in Children after Traumatic Brain Injury—Preliminary Experience

• DOI: 10.1371/journal.pone.0148817
• Publication Date: 2016-03-15T20:04:46Z
• Authors: Adam M. H. Young; Joseph Donnelly; Marek Czosnyka; Ibrahim Jalloh; Xiuyun Liu; Marcel J. Aries; Helen M. Fernandes; Matthew R. Garnett; Peter Smielewski; Peter J. Hutchinson; Shruti Agrawal
• Keywords: Intracranial pressure monitoring

Introduction Multimodality monitoring is regularly employed in adult traumatic brain injury (TBI) patients where it provides physiologic and therapeutic insight into this heterogeneous condition. Pediatric studies are less frequent. Methods An analysis of data collected prospectively from 12 pediatric TBI admitted to Addenbrooke’s Hospital, Intensive Care Unit (PICU) between August 2012 December 2014 was performed. Patients’ intracranial pressure (ICP), mean arterial (MAP), cerebral perfusion (CPP) were monitored continuously using software ICM+®,) Pressure reactivity index (PRx) ‘Optimal CPP’ (CPPopt) calculated. Patient outcome dichotomized survivors non-survivors. Results At 6 months 8/12 (66%) the cohort survived TBI. The median (±IQR) ICP significantly lower 13.1±3.2 mm Hg compared non-survivors 21.6±42.9 (p = 0.003). time spent with over 20 (9.7+9.8% vs 60.5+67.4% non-survivors; p Although there no evidence that CPP different survival groups, a close (within 10 Hg) optimal longer (90.7±12.6%) (70.6±21.8%; 0.02). PRx provided significant separation being 0.02±0.19 0.39±0.62 Conclusion Our observations provide multi-modality may be useful ICP, deviation CPPopt, correlating patient outcome.