Intracranial pressure and cerebral perfusion pressure as risk factors in children with traumatic brain injuries.
OBJECTIVE
The authors evaluated the initial intracranial pressure (ICP) and cerebral perfusion pressure (CPP) as prognostic factors in severe head injury in children and tried to determine the optimal CPP range.


METHODS
The authors performed a 9-year retrospective review of all patients with severe traumatic brain injuries (TBIs) who required invasive ICP monitoring and were admitted to the pediatric intensive care unit at their institution between January 1995 and December 2003. These patients had Glasgow Coma Scale scores lower than 8 and/or required ICP monitoring due to worsening neurological status or neuroimaging results suggestive of cerebral hypertension. Clinical summaries and imaging studies were reviewed. Data for 156 pediatric patients who ranged in age from 1 to 18 years were obtained. Half of these patients presented with normal initial ICPs (< 20 mm Hg), and a good outcome was achieved in 80% of these children. An unfavorable outcome was observed in more than 60% of patients with an initial CPP lower than 40 mm Hg. The proportion of patients with an unfavorable outcome decreased to 10% with initial CPPs higher than 60 mm Hg, but patients with initial CPPs higher than 70 mm Hg did not improve.


CONCLUSIONS
Initial ICP and CPP measurements were useful as prognostic factors in pediatric patients with severe TBIs: patients with initial CPPs between 40 and 70 mm Hg were found to have a better neurological prognosis than those with CPPs either higher or lower than that range.
Català-Temprano
Albert
A
Pediatric Intensive Care Unit, Pediatrics Department, Integrated Unit Sant Joan de Déu-Clínic, Hospital Universitari Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain. acatala@hsjdbcn.org
Claret Teruel
Gemma
G
Cambra Lasaosa
Francisco Josè
FJ
Pons Odena
Martì
M
Noguera Julián
Antoni
A
Palomeque Rico
Antonio
A
D000293:Adolescent; D001794:Blood Pressure; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000188:drug therapy / Q000209:etiology; D007427:Intracranial Pressure; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome