title: Continuous Multimodality Monitoring in Children after Traumatic Brain Injury-Preliminary Experience.
abstract: BACKGROUND
  Multimodality monitoring is regularly employed in adult traumatic brain injury (TBI) patients where it provides physiologic and therapeutic insight into this heterogeneous condition. Pediatric studies are less frequent.
  
  
  METHODS
  An analysis of data collected prospectively from 12 pediatric TBI patients admitted to Addenbrooke's Hospital, Pediatric Intensive Care Unit (PICU) between August 2012 and December 2014 was performed. Patients' intracranial pressure (ICP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) were monitored continuously using brain monitoring software ICM+®,) Pressure reactivity index (PRx) and 'Optimal CPP' (CPPopt) were calculated. Patient outcome was dichotomized into survivors and non-survivors.
  
  
  RESULTS
  At 6 months 8/12 (66%) of the cohort survived the TBI. The median (±IQR) ICP was significantly lower in survivors 13.1±3.2 mm Hg compared to non-survivors 21.6±42.9 mm Hg (p = 0.003). The median time spent with ICP over 20 mm Hg was lower in survivors (9.7+9.8% vs 60.5+67.4% in non-survivors; p = 0.003). Although there was no evidence that CPP was different between survival groups, the time spent with a CPP close (within 10 mm Hg) to the optimal CPP was significantly longer in survivors (90.7±12.6%) compared with non-survivors (70.6±21.8%; p = 0.02). PRx provided significant outcome separation with median PRx in survivors being 0.02±0.19 compared to 0.39±0.62 in non-survivors (p = 0.02).
  
  
  CONCLUSIONS
  Our observations provide evidence that multi-modality monitoring may be useful in pediatric TBI with ICP, deviation of CPP from CPPopt, and PRx correlating with patient outcome.
authors.affiliation: Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Adam M H
authors.initials: AM
authors.lastname: Young
authors.affiliation: Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Joseph
authors.initials: J
authors.lastname: Donnelly
authors.affiliation: Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.|Institute of Electronic Systems, Warsaw University of Technology, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Czosnyka
authors.affiliation: Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Jalloh
authors.affiliation: Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Xiuyun
authors.initials: X
authors.lastname: Liu
authors.affiliation: Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.|Department of Intensive Care, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Marcel J
authors.initials: MJ
authors.lastname: Aries
authors.affiliation: Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Fernandes
authors.affiliation: Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Garnett
authors.affiliation: Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Smielewski
authors.affiliation: Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hutchinson
authors.affiliation: Department of Pediatric Intensive Care, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Shruti
authors.initials: S
authors.lastname: Agrawal
mesh_terms: D001794:Blood Pressure; D001930:Brain Injuries / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007427:Intracranial Pressure; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D064847:Multimodal Imaging; D011446:Prospective Studies