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Intracranial pressure and cerebral perfusion pressure responses to head elevation changes in pediatric traumatic

Rachel S Agbeko1, Sean Pearson, Mark J Peters

  • 1Paediatric Intensive Care Unit, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|January 19, 2011
PubMed

Insights

Head elevation significantly reduces intracranial pressure in children with severe traumatic brain injury. Cerebral perfusion pressure remained largely unaffected by changes in head-of-the-bed positioning.

Area of Science:

  • Pediatric Critical Care Medicine
  • Neurocritical Care
  • Trauma Surgery

Background:

  • Severe pediatric traumatic brain injury presents complex management challenges.
  • Maintaining optimal intracranial pressure (ICP) and cerebral perfusion pressure (CPP) is critical for patient outcomes.
  • Head-of-the-bed (HOB) elevation is a common intervention, but its precise effects in pediatric TBI require further elucidation.

Purpose of the Study:

  • To investigate the dynamic relationship between head elevation and ICP/CPP in children with severe traumatic brain injury.
  • To determine how changes in HOB angle influence ICP and CPP in this vulnerable population.

Main Methods:

  • Prospective, randomized, interventional cohort study conducted in two tertiary pediatric critical care units.
  • Ten children (mean age 10 ± 5 years) with severe traumatic brain injury (Glasgow Coma Score ≤ 8) underwent ICP monitoring.
  • HOB angle was randomized between 0 and 40 degrees in 10-degree increments, with continuous ICP and arterial blood pressure monitoring.

Main Results:

  • An increase in HOB elevation of 10 cm resulted in a significant average decrease in ICP of -3.9 mm Hg (p < .001).
  • Cerebral perfusion pressure remained largely unchanged (0.1 ± 5.6 mm Hg; p = .957) across different HOB angles.
  • Individual responses varied, with ICP changes ranging from -8.4 to +1.9 mm Hg/10 cm; the effect size was influenced by patient height.

Conclusions:

  • Head elevation demonstrates a negative, linear correlation with ICP in pediatric severe traumatic brain injury.
  • While highest HOB angles often yielded the lowest ICP, CPP was generally not significantly affected by HOB position.
  • Patient height is a factor influencing the ICP response to HOB elevation changes.
Abstract

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