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A study of the effects of using different cerebral perfusion pressure (CPP) thresholds to quantify CPP "secondary
S Jackson1, I R Piper, A Wagstaff
1Institute of Neurological Sciences, Southern General Hospital, Glasgow.
Insights
Cerebral perfusion pressure (CPP) insults are common in children, occurring more frequently than in adults. These insults, especially when CPP drops below 50 mmHg, are associated with increased intracranial pressure (ICP).
Area of Science:
- Pediatric Neurocritical Care
- Cerebrovascular Physiology
- Intensive Care Medicine
Background:
- Secondary insults, particularly those affecting cerebral perfusion pressure (CPP), are not well understood in pediatric populations.
- Understanding the incidence and impact of CPP insults in children is crucial for improving neurocritical care outcomes.
Purpose of the Study:
- To determine the duration of CPP insults at specific thresholds (<70, <60, <50 mmHg) in children.
- To investigate the relationship between CPP insults and patient outcomes.
- To compare the incidence of CPP insults in children versus adults.
Main Methods:
- Continuous monitoring of intracranial pressure (ICP), mean arterial pressure (MAP), and CPP in 18 pediatric patients (<16 years) admitted to a Neuro-ICU.
- Utilized the Edinburgh secondary insult analysis program to identify CPP insults at defined thresholds.
- Assessed patient outcomes using the Glasgow Outcome Scale.
Main Results:
- CPP was below 70 mmHg for 30% of the time, below 60 mmHg for 21%, and below 50 mmHg for 8% of the monitored period.
- Children exhibited more than double the incidence of CPP insults across all thresholds compared to adult data.
- A significant increase in ICP was observed as CPP decreased, particularly when CPP fell below 50 mmHg (average ICP >30 mmHg).
Conclusions:
- CPP insults are a common occurrence in pediatric neurocritical care.
- The incidence of CPP insults is higher in children than in adults.
- Further research with larger datasets and longer follow-up is needed to identify factors influencing outcomes in children experiencing CPP insults.
Abstract:
Little is known about the incidence of secondary insults, particularly cerebral perfusion pressure insults, in children. The objectives of this study were to assess the duration of CPP insults at three different thresholds in children and to relate CPP insults to outcome. Eighteen children (age < 16, median & mean 8 years) admitted to the Neurointensive Care Unit who had ICP, MAP and CPP continuously monitored were studied. Using the Edinburgh secondary insult analysis program, data was scanned for CPP insults at three different thresholds: CPP < 70 mmHg, < 60 mmHg and < 50 mmHg. Outcome was assessed using the Glasgow Outcome Scale. Thirty percent of the time CPP was between 60 and 70 mmHg, 21% of the time CPP was between 50 and 60 mmHg and 8% of the time the CPP was less than 50 mmHg. Compared with adults, there was more than twice the incidence of CPP insults in all threshold groups. BP remained relatively stable above 70 mmHg across all three CPP threshold groups. However, ICP increased slightly on average from about 13-->17 mmHg when CPP decreased from the < 70 to < 60 mmHg group (p < 0.001). There was a marked increase in ICP to greater than 30 mmHg on average in the CPP < 50 mmHg group (p < 0.001). CPP insults less than 70, 60 and 50 mmHg do occur commonly in children, a larger dataset and possibly longer term follow up measures will be needed to identify potentially treatable physiological factors most effecting the outcome of children.
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