title: Intraoperative blood loss during decompressive craniectomy for intractable intracranial hypertension after severe traumatic brain injury in children.
abstract: OBJECTIVE
  There are no data available on the risk of intraoperative bleeding during decompressive craniectomy (DC) after traumatic brain injury (TBI) in children. The objectives of this study were to assess the risk of intraoperative bleeding during DC for intractable intracranial hypertension after TBI, to identify potential factors associated with the risk of bleeding during DC, and to assess the impact of DC on systemic and cerebral hemodynamics and on coagulation.
  
  
  METHODS
  Twelve children were identified as having undergone DC after TBI from April 2009 to June 2013 in our center. Subjects were allocated into two groups according to the percentage of blood loss (IBL) during the intraoperative period (<or ≥50 % of the estimated blood volume (EBV)).
  
  
  RESULTS
  The median IBL during DC was 49 [17-349] % of the EBV. Children with an IBL ≥ 50 % of EBV had higher preoperative intracranial pressure (ICP) (p = 0.03) and international normalized ratio (INR) (p = 0.02) than those with an IBL < 50 % of EBV. DC induced significant decreases in ICP (p = 0.0005), mean arterial pressure (p = 0.01), and a significant increase in norepinephrine flow rate (p = 0.04) between the immediate pre- and postoperative periods.
  
  
  CONCLUSIONS
  DC allows a significant decrease in ICP after severe pediatric TBI but is a surgical procedure at a high risk of bleeding. High ICP and INR during the immediate preoperative period are the main factors associated with increased IBL during DC. Further studies are needed to confirm our results and to assess the impact of the amount of IBL on the postoperative survival and functional outcome.
authors.affiliation: Department of Pediatric Anesthesia, Hôpital Femme Mère Enfant (Hospices Civils de Lyon), Université Claude Bernard Lyon 1, Lyon, France, fp_desgranges@yahoo.fr.
authors.forename: François-Pierrick
authors.initials: FP
authors.lastname: Desgranges
authors.forename: Etienne
authors.initials: E
authors.lastname: Javouhey
authors.forename: Carmine
authors.initials: C
authors.lastname: Mottolese
authors.forename: Anne
authors.initials: A
authors.lastname: Migeon
authors.forename: Alexandru
authors.initials: A
authors.lastname: Szathmari
authors.forename: Florent
authors.initials: F
authors.lastname: Baudin
authors.forename: Mathilde
authors.initials: M
authors.lastname: de Queiroz
authors.forename: Bérengère
authors.initials: B
authors.lastname: Cogniat
authors.forename: Dominique
authors.initials: D
authors.lastname: Chassard
mesh_terms: D000293:Adolescent; D016063:Blood Loss, Surgical; D001930:Brain Injuries / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology* / Q000601:surgery*; D008297:Male; D012720:Severity of Illness Index; D013997:Time Factors
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