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Pediatric Critical Care Medicine:
doi: 10.1097/01.pcc.0000448739.07731.d6
Abstracts of the 7th World Congress on Pediatric Critical Care

ABSTRACT 10: OPTIMAL CEREBRAL PERFUSION PRESSURE AND OUTCOME IN PAEDIATRIC BRAIN TRAUMA

Lo, T.Y.M.1; Grandas, F.G.2; Jones, P.A.3; Chambers, I.R.4; Mendelow, A.D.5; Forsyth, R.6; Depreitere, B.7; Meyfroidt, G.2; Minns, R.A.3

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1Paediatric Intensive Care Medicine, Royal Hospital for Sick Children, Edinburgh, United Kingdom 2Intensive Care Medicine, University Hospital, Leuven, Belgium 3Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom 4Medical Physics, James Cook University Hospital, Middlesbrough, United Kingdom 5Neurosurgery, Newcastle General Hospital, Newcastle upon Tyne, United Kingdom 6Paediatric Neurology, Newcastle General Hospital, Newcastle upon Tyne, United Kingdom 7Neurosurgery, University Hospital, Leuven, Belgium

Background and aims: In paediatric traumatic brain injury (TBI), age-related critical cerebral perfusion pressure (CPP) insult thresholds were defined but optimal CPP treatment thresholds remain unknown. Cerebrovascular autoregulatory capacity varies between patients and time post-injury, making optimal CPP (CPPopt) likely to vary throughout TBI management.

Aims: We aimed to determine if CPPopt varies in paediatric TBI and its relationship to outcome.

Methods: Prospectively collected physiological data in minute-resolution of 81 TBI patients recruited from 2 regional centres was analysed retrospectively to calculate CPPopt using a Low-frequency Autoregulation Index (LAx)-CPP plots. LAx was defined as the minute-by-minute ICP/MAP correlation coefficient over time intervals. Relationship between CPPopt and 6-month global post-injury outcome, quantified using the modified Glasgow Outcome Score (mGOS), was determined. IRB approved the study protocol and written informed consent was obtained.

Results: CPPopt varied with time for each patient during their PICU stay (range 42.5 to 117.5 mmHg). Median overall CPPopt for children aged 2–6 years, 7–11 years, and 12–16 years was 68.83, 68.09, and 72.17 mmHg respectively. Significantly higher proportions of CPP monitoring time were within CPPopt among survivors (p = 0.04) and patients with favourable outcome i.e. GOS 4&5 (p = 0.01). The difference between CPP and CPPopt significantly differentiated between patients with favourable and unfavourable outcome (p = 0.037). Patients with unfavourable outcome were significantly more likely to have CPP levels below CPPopt (p = 0.04).

Conclusions: CPPopt vary with time after childhood TBI and clinically relevant patient specific real-time CPPopt derived from routine pressure data may affect outcome.

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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