Change in cerebral autoregulation as a function of time in children after severe traumatic brain injury: a case series.
OBJECTIVE
The objective of this study was to describe changes in cerebral autoregulation after severe pediatric traumatic brain injury (TBI).


METHODS
Two cerebral autoregulation tests were performed during the first 10 days after severe TBI in children <16 years. Cerebral autoregulation was quantified using the mean autoregulatory index (mARI).


RESULTS
Nine (five males/four females) children (10 +/- 5 years) with severe (admission Glasgow Coma Scale (GCS), 5 +/- 2) TBI were enrolled. Thirty (3/9) percent of initial exams revealed impaired cerebral autoregulation; all three had returned to intact cerebral autoregulation on second exam. However, in three of nine (33%) patients, cerebral autoregulation worsened on second exam. Of the factors examined, worsening mARI on second exam was associated with worsening head computed tomography (CT) lesion.


CONCLUSIONS
Cerebral autoregulation often changed and worsened during the first 9 days after severe pediatric TBI. Worsening cerebral autoregulation may mirror worsening TBI.
Tontisirin
Nuj
N
Department of Anesthesiology, Harborview Medical Center, 325 Ninth Avenue, P.O. Box 359724, Seattle, WA 98104, USA.
Armstead
William
W
Waitayawinyu
Pichaya
P
Moore
Anne
A
Udomphorn
Yuthana
Y
Zimmerman
Jerry J
JJ
Chesnut
Randall
R
Vavilala
Monica S
MS
D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology; D001921:Brain / Q000503:physiopathology*; D001930:Brain Injuries / Q000503:physiopathology*; D002245:Carbon Dioxide / Q000097:blood; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D020768:Middle Cerebral Artery / Q000502:physiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D002245:Carbon Dioxide