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Relationship of cerebral perfusion pressure and survival in pediatric brain-injured patients

C Downard1, F Hulka, R J Mullins

  • 1Department of Surgery, Oregon Health Sciences University, Portland 97201, USA.

The Journal of Trauma
|October 19, 2000
PubMed

Insights

Maintaining cerebral perfusion pressure (CPP) above 40 mm Hg is critical for pediatric brain injury survival. However, CPP levels did not predict outcomes in children with survivable brain injuries.

Area of Science:

  • Pediatric neurocritical care
  • Traumatic brain injury management
  • Intensive care medicine

Background:

  • Adult studies suggest maintaining cerebral perfusion pressure (CPP) above 70 mm Hg after brain injury.
  • The impact of CPP on outcomes in pediatric traumatic brain injury (TBI) requires further investigation.

Purpose of the Study:

  • To evaluate the relationship between CPP and patient outcomes in children with severe TBI.
  • To determine if CPP thresholds can predict mortality or functional outcomes in pediatric TBI.

Main Methods:

  • Retrospective review of 188 pediatric patients with TBI requiring intracranial pressure (ICP) monitoring at two Level I trauma centers.
  • Hourly ICP, CPP, and mean arterial pressure were recorded and averaged for the first 48 hours post-injury.
  • Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) were used to assess neurological status and outcome.

Main Results:

  • 118 children with severe TBI (average GCS 6 ± 3) had ICP monitors placed within 24 hours.
  • Overall mortality was 28%; no patient with a mean CPP < 40 mm Hg survived.
  • No significant difference in GOS distribution was observed for patients with mean CPP between 40-70 mm Hg.

Conclusions:

  • Low mean CPP (< 40 mm Hg) is associated with lethality in pediatric TBI.
  • In children with TBI and CPP > 40 mm Hg, CPP alone did not effectively stratify risk for adverse outcomes.
  • Targeting CPP in pediatric TBI may require further refinement beyond simple threshold values.
Abstract

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