title: Variations of the blood gas levels and thermodilutional parameters during ICP monitoring after severe head trauma in children.
abstract: OBJECTIVE
  The purpose of this study was to define, in children following head trauma and GSC ≤ 8, at which level of intracranial pressure (ICP), the thermodilutional, and gas analytic parameters implicated in secondary cerebral insults shows initial changes.
  
  
  METHODS
  We enrolled in the study 56 patients: 30 males and 26 females, mean age 71 ± 52 months. In all children, volumetric hemodynamic and blood gas parameters were monitored following initial resuscitation and every 4 h thereafter or whenever a hemodynamic deterioration was suspected. During the cumulative hospital stay, a total of 1050 sets of measurements were done. All parameters were stratified in seven groups according to ICP (group A1 = 0-5 mmHg, group A2 = 6-10 mmHg, group A3 = 11-15 mmHg, group A4 16-20 mmHg, group A5 21-25 mmHg, group A6 26-30 mmHg, group A7 >31 mmHg).
  
  
  RESULTS
  Mean values of jugular oxygen saturation (SJO2), jugular oxygen partial pressure (PJO2), extravascular lung water (EVLWi), pulmonary vascular permeability (PVPi), fluid overload (FO), and cerebral extraction of oxygen (CEO2) vary significantly from A3 (11-15 mmHg) to A4 (16-20 mmHg). They relate to ICP in a four-parameter sigmoidal function (4PS function with: r(2) = 0.90), inflection point of 15 mmHg of ICP, and a maximum curvature point on the left horizontal asymptote at 13 mmHg of ICP.
  
  
  CONCLUSIONS
  Mean values of SJO2, PJO2, EVLWi, PVPi, FO, and CEO2 become pathologic at 15 mmHg of ICP; however, the curve turns steeper at 13 mmHg, possibly a warning level in children for the development of post head trauma secondary insult.
authors: Dipartimento di Pediatria, CEQUAM, Sapienza Università di Roma, Viale Regina Elena 324, 00161, Rome, Italy, riccardo.lubrano@uniroma1.it.
authors: Riccardo
authors: R
authors: Lubrano
authors: Marco
authors: M
authors: Elli
authors: Francesca
authors: F
authors: Stoppa
authors: Mario
authors: M
authors: Di Traglia
authors: Matteo
authors: M
authors: Di Nardo
authors: Daniela
authors: D
authors: Perrotta
authors: Piero
authors: P
authors: David
authors: Sara
authors: S
authors: Paoli
authors: Corrado
authors: C
authors: Cecchetti
mesh_terms: D000293:Adolescent; D001784:Blood Gas Analysis; D057785:Catheters; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007223:Infant; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood*
chemical_list: D010100:Oxygen