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Cerebrovascular Pressure Reactivity in Children With Traumatic Brain Injury

Philip M Lewis1, Marek Czosnyka, Bradley G Carter

  • 11Department of Neurosurgery, Alfred Hospital, Melbourne, VIC, Australia. 2Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia. 3Neurosurgical Unit, Department of Clinical Neurosciences, Cambridge University, Cambridge, United Kingdom. 4Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland. 5Clinical Technology Service, Paediatric Intensive Care Unit, Royal Children's Hospital, Parkville, VIC, Australia. 6Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD. 7Department of Clinical Haematology, Alfred Hospital, Melbourne, VIC, Australia. 8Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 9Paediatric Intensive Care Unit, Royal Children's Hospital, Parkville, VIC, Australia. 10Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|July 2, 2015
PubMed

Insights

The pressure-reactivity index (PRI) shows prognostic value in pediatric traumatic brain injury, correlating with outcomes. Optimizing cerebral perfusion pressure (CPP) using PRI may improve patient results in pediatric TBI.

Area of Science:

  • Neuroscience
  • Pediatric Critical Care Medicine
  • Neurological Surgery

Background:

  • Traumatic brain injury (TBI) is a major cause of death and disability in children.
  • Cerebral autoregulation, crucial for brain function, is often impaired after TBI.
  • Pressure reactivity, a key aspect of cerebral autoregulation, can be assessed using the pressure-reactivity index (PRI).

Purpose of the Study:

  • To investigate the prognostic value of the pressure-reactivity index (PRI) in pediatric traumatic brain injury (TBI).
  • To determine the association between PRI, optimal cerebral perfusion pressure (CPP), age, and outcomes in pediatric TBI.
  • To explore the relationship between CPP management and patient outcomes in pediatric TBI.

Main Methods:

  • A prospective observational study was conducted in a pediatric intensive care unit (ICU).
  • Patients aged 6 months to 16 years with TBI requiring invasive monitoring were included.
  • Arterial blood pressure, intracranial pressure, and end-tidal CO2 were continuously monitored; PRI and optimal CPP were calculated.

Main Results:

  • The PRI correlated with the modified Glasgow Outcome Score (mGOOS) at 6 months post-discharge (Spearman ρ = 0.42; p = 0.023).
  • Higher PRI values were observed in patients with unfavorable outcomes (0.23 vs -0.09; p = 0.0009).
  • Optimal CPP increased with age (ρ = 0.40; p = 0.02), and deviations from optimal CPP were linked to poorer outcomes.

Conclusions:

  • The pressure-reactivity index (PRI) demonstrates prognostic significance in pediatric traumatic brain injury (TBI).
  • PRI can identify individualized cerebral perfusion pressure (CPP) targets, potentially differing from standard protocols.
  • Further prospective studies are warranted to confirm if CPP targeting guided by PRI improves outcomes in pediatric TBI.
Abstract

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