• Pediatrics · Dec 2009

    Continuous monitoring of cerebrovascular pressure reactivity after traumatic brain injury in children.

    • Ken M Brady, Donald H Shaffner, Jennifer K Lee, R Blaine Easley, Peter Smielewski, Marek Czosnyka, George I Jallo, and Anne-Marie Guerguerian.
    • Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Department of aAnesthesiology and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21287, USA. kbrady5@jhmi.edu
    • Pediatrics. 2009 Dec 1;124(6):e1205-12.

    ObjectiveWe hypothesized that pressure reactivity index (PRx) values indicating preserved cerebrovascular pressure autoregulation would be associated with survival in children with traumatic brain injury (TBI). This hypothesis was tested in a prospective, blinded, observational, pilot study.MethodsTwenty-one children admitted between May 2006 and September 2008 with severe TBI necessitating invasive intracranial pressure monitoring were enrolled in this study. The PRx was continuously monitored as a moving, linear correlation coefficient between low-frequency waves of intracranial and arterial blood pressures. Positive values of PRx approaching 1 indicate impaired cerebrovascular pressure reactivity, whereas negative PRx values or values close to 0 indicate preserved cerebrovascular pressure reactivity. Survival was the primary outcome and was compared with the average PRx value obtained during the intracranial pressure-monitoring period.ResultsPRx was associated with survival in this cohort; survivors (N = 15) had a mean PRx +/- SD of 0.08 +/- 0.19, and nonsurvivors (N = 6) had a mean PRx of 0.69 +/- 0.21 (P = .0009). In this sample, continuous PRx monitoring suggested impaired cerebrovascular pressure reactivity at low levels of cerebral perfusion pressure (CPP) and intact cerebrovascular pressure reactivity at higher levels of CPP.ConclusionsIntact cerebrovascular pressure reactivity quantified with the PRx is associated with survival after severe head trauma in children. The PRx is CPP dependent in children. The PRx may be useful for defining age-specific and possibly patient-specific optimal targets for CPP after TBI.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…