title: Neurointensive care; impaired cerebral autoregulation in infants and young children early after inflicted traumatic brain injury: a preliminary report.
abstract: The objective of this report is to describe cerebral autoregulation after severe inflicted pediatric traumatic brain injury (iTBI). We examined cerebral autoregulation of both cerebral hemispheres (mean autoregulatory index; ARI) in children <5 years with Glasgow Coma Scale (GCS) score of <9 and no evidence of brain death within the first 48 h of pediatric intensive care unit (PICU) admission. Discharge and 6-month Glasgow Outcome Scale (GOS) scores were collected. GOS of <4 reflected poor outcome. All three iTBI and all seven noninflicted TBI (nTBI) patients had admission GCS score of <9. Eight of 10 patients had Autoregulatory Index (ARI) of <0.4 (impaired cerebral autoregulation) of at least one hemisphere. All children with iTBI had poor outcome, and none had intact cerebral autoregulation in both hemispheres. Children with nTBI had better overall outcome than those with iTBI. Two of the children with nTBI had intact autoregulation in both hemispheres and good outcome. Two of the three children with iTBI had differential effects on autoregulation between hemispheres despite bilateral injury. These are, to our knowledge, the first data on cerebral blood flow autoregulation in the unique setting of iTBI and provide a rationale for further study of their relationship to outcome and effects of therapy.
authors.affiliation: Department of Anesthesiology, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA. vavilala@u.washington.edu
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
authors.forename: Saipin
authors.initials: S
authors.lastname: Muangman
authors.forename: Pichaya
authors.initials: P
authors.lastname: Waitayawinyu
authors.forename: Ceceila
authors.initials: C
authors.lastname: Roscigno
authors.forename: Kenneth
authors.initials: K
authors.lastname: Jaffe
authors.forename: Pamela
authors.initials: P
authors.lastname: Mitchell
authors.forename: Catherine
authors.initials: C
authors.lastname: Kirkness
authors.forename: Jerry J
authors.initials: JJ
authors.lastname: Zimmerman
authors.forename: Richard
authors.initials: R
authors.lastname: Ellenbogen
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Lam
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D001921:Brain / Q000503:physiopathology*; D001930:Brain Injuries / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D023261:Glasgow Outcome Scale; D006400:Hematocrit; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007223:Infant; D008297:Male; D020768:Middle Cerebral Artery / Q000503:physiopathology; D016896:Treatment Outcome