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Cerebrovascular response in children following severe traumatic brain injury

P David Adelson1, Ravi Srinivas, Yuefang Chang

  • 1Phoenix Children's Neuroscience Institute and Pediatric Neurosurgery, AZ 85016, USA. dadelson@phoenixchildrens.com

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|May 12, 2011
PubMed

Insights

Cerebral blood flow (CBF) and CO2 vasoreactivity are critical in pediatric traumatic brain injury (TBI). Low CBF and impaired CO2VR correlate with poorer outcomes in children with severe TBI.

Area of Science:

  • Pediatric neurocritical care
  • Traumatic brain injury research
  • Cerebrovascular physiology

Background:

  • Severe traumatic brain injury (TBI) in children, defined by a Glasgow Coma Score (GCS) of ≤8, presents complex pathophysiologic challenges.
  • Understanding cerebral blood flow (CBF) and autoregulation is crucial for managing pediatric TBI and improving patient outcomes.

Purpose of the Study:

  • To characterize the pathophysiologic response of CBF and autoregulation in children with severe TBI.
  • To establish a baseline for CBF and CO2 vasoreactivity (CO2VR) in this vulnerable population for future research.

Main Methods:

  • A retrospective chart review of 95 pediatric patients (ages 0.1-18.4 years) with severe TBI was conducted.
  • Cerebral blood flow (CBF) was measured using Xenon Computerized Tomography (XeCT) up to post-injury day 9.
  • CO2 vasoreactivity (CO2VR) was assessed in 27 patients by manipulating PaCO2 levels.

Main Results:

  • Mean CBF on admission was 32.05 ml/100 g/min, with eight patients showing CBF ≤20 ml/100 g/min.
  • Mean CBF increased by post-injury day 1-2 to 55.36 ml/100 g/min.
  • Significantly lower mean CBF was observed in patients with unfavorable outcomes (GOS ≤3) compared to favorable outcomes (GOS ≥4).
  • All patients with CBF ≤20 ml/100 g/min during post-injury days 0-2 had unfavorable outcomes.
  • CO2VR <2%/Torr PaCO2 within post-injury days 0-2 was significantly associated with unfavorable outcomes (P = 0.029).

Conclusions:

  • Younger age, persistently low CBF (early or late), and impaired CO2VR (<2%/Torr PaCO2) are correlated with poorer outcomes in children following severe TBI.
  • This study represents the largest experience using XeCT for CBF measurement in children with TBI.
  • Findings confirm previous reports of low early CBF, disturbed CO2VR, and the association between low CBF and unfavorable outcomes in pediatric TBI.
Abstract

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