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Published on: March 26, 2019
Admission oxygenation and ventilation parameters associated with discharge survival in severe pediatric traumatic
Vijay Kumar Ramaiah1, Deepak Sharma, Li Ma
1Department of Anesthesiology and Pain Medicine, Harborview Medical Center, 325 Ninth Avenue, PO Box 359724, Seattle, WA 98104, USA.
Insights
Maintaining optimal oxygen and carbon dioxide levels upon admission is crucial for pediatric traumatic brain injury (TBI) survival. Specific blood gas parameters, PaO2 301-500 mmHg and PaCO2 36-45 mmHg, are linked to better outcomes in severe pediatric TBI.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Emergency medicine
Background:
- Severe pediatric traumatic brain injury (TBI) requires careful management of physiological parameters.
- Current guidelines recommend avoiding hypoxemia but lack data on optimal oxygenation and ventilation.
- Understanding admission parameters associated with survival is critical for improving patient outcomes.
Purpose of the Study:
- To investigate the association between admission oxygenation and ventilation parameters and discharge survival in severe pediatric TBI patients.
- To identify specific blood gas levels linked to improved survival rates.
Main Methods:
- Retrospective study of pediatric patients (≤14 years) with severe TBI (head AIS ≥3, GCS ≤8).
- Data collected included admission demographics, clinical data, and laboratory characteristics.
- Hypoxemia (PaO2 < 60 mmHg), hypocarbia (PaCO2 ≤ 35 mmHg), and hypercarbia (PaCO2 ≥ 46 mmHg) were defined.
Main Results:
- Out of 194 patients, 162 (83.5%) survived.
- Admission hypoxemia was significantly more common in non-survivors (25%) than survivors (5.6%).
- Optimal PaCO2 (36-45 mmHg) was associated with greater survival compared to hypocarbia or hypercarbia. Admission PaO2 301-500 mmHg and PaCO2 36-45 mmHg were independently associated with survival.
Conclusions:
- Admission oxygenation (PaO2 301-500 mmHg) and ventilation (PaCO2 36-45 mmHg) parameters are independently associated with discharge survival in severe pediatric TBI.
- Both admission hypocarbia and hypercarbia are linked to increased mortality in this population.
- These findings support optimizing blood gas parameters in the acute management of pediatric TBI.
Purpose:
Current Brain Trauma Foundation guidelines recommend avoiding hypoxemia after severe pediatric traumatic brain injury (TBI). Yet, recent studies on optimum admission oxygenation and ventilation parameters associated with discharge survival in pediatric TBI are lacking.
Materials And Methods:
After IRB approval, a retrospective study involving pediatric patients ages ≤14 years with severe TBI (head Abbreviated Injury Scale (AIS) score of ≥3, Glasgow Coma Scale score of ≤8 on admission) admitted to Harborview Medical Center (level 1 pediatric trauma center), Seattle, WA, during 2003 to 2007 was performed. Admission demographics, clinical data, and laboratory characteristics were abstracted. Hypoxemia was defined as PaO2 < 60 mmHg, hypocarbia was defined as PaCO2 ≤ 35 mmHg, and hypercarbia was defined as PaCO2 ≥ 46 mmHg.
Results:
One hundred ninety-four patients met inclusion criteria of which 162 (83.5 %) patients survived. Admission hypoxemia occurred in nine (5.6 %) patients who survived and eight (25 %) patients who died (p < 0.001). Children with admission PaCO2 between 36 and 45 mmHg had greater discharge survival compared with those with both admission hypocarbia (PaCO2 ≤ 35 mmHg) and hypercarbia (PaCO2 ≥ 46 mmHg). Admission PaO2 301-500 mmHg (adjusted odds ratio (AOR), 8.02 (95 % confidence interval (CI), 1.73-37.10); p = 0.008) and admission PaCO2 = 36-45 mmHg (AOR, 5.47 (95 % CI, 1.30-23.07); p = 0.02) were independently associated with discharge survival.
Conclusions:
Discharge survival after severe pediatric TBI was associated with admission PaO2 301-500 mmHg and PaCO2 = 36-45 mmHg. Admission hypocarbia and hypercarbia were each associated with increased discharge mortality.
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