• François-Pierrick Desgranges, Etienne Javouhey, Carmine Mottolese, Anne Migeon, Alexandru Szathmari, Florent Baudin, Mathilde de Queiroz, Bérengère Cogniat, and Dominique Chassard.
• Department of Pediatric Anesthesia, Hôpital Femme Mère Enfant (Hospices Civils de Lyon), Université Claude Bernard Lyon 1, Lyon, France, fp_desgranges@yahoo.fr.
• Childs Nerv Syst. 2014 Aug 1; 30 (8): 1393-8.

PurposeThere 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.MethodsTwelve 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 (ResultsThe 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.ConclusionsDC 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.

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