Related Experiment Video
Updated: Mar 24, 2026
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Continuous Multimodality Monitoring in Children after Traumatic Brain Injury-Preliminary Experience
Adam M H Young1, Joseph Donnelly1, Marek Czosnyka1,2
1Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
Insights
Multimodality monitoring in pediatric traumatic brain injury (TBI) shows promise. Lower intracranial pressure (ICP) and optimal cerebral perfusion pressure (CPP) correlate with better outcomes in TBI survivors.
Area of Science:
- Pediatric Intensive Care
- Neurocritical Care
- Traumatic Brain Injury Research
Background:
- Multimodality monitoring is standard in adult TBI but less studied in pediatric TBI.
- Pediatric TBI presents unique challenges due to developmental differences.
- Understanding physiologic parameters is crucial for managing pediatric TBI.
Purpose of the Study:
- To evaluate the utility of multimodality monitoring in pediatric TBI.
- To correlate monitored parameters with patient outcomes.
- To assess the relationship between ICP, CPP, and PRx with survival in pediatric TBI.
Main Methods:
- Prospective analysis of 12 pediatric TBI patients.
- Continuous monitoring of ICP, MAP, and CPP using ICM+® software.
- Calculation of Pressure Reactivity Index (PRx) and optimal CPP (CPPopt).
Main Results:
- 66% of pediatric TBI patients survived at 6 months.
- Survivors had significantly lower median ICP and less time with ICP > 20 mm Hg.
- Survivors spent more time with CPP close to CPPopt and had lower PRx values.
Conclusions:
- Multimodality monitoring appears beneficial in pediatric TBI.
- ICP, CPP deviation from CPPopt, and PRx correlate with patient outcomes.
- These findings support the use of advanced monitoring in pediatric neurocritical care.
Introduction:
Multimodality monitoring is regularly employed in adult traumatic brain injury (TBI) patients where it provides physiologic and therapeutic insight into this heterogeneous condition. Pediatric studies are less frequent.
Methods:
An analysis of data collected prospectively from 12 pediatric TBI patients admitted to Addenbrooke's Hospital, Pediatric Intensive Care Unit (PICU) between August 2012 and December 2014 was performed. Patients' intracranial pressure (ICP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) were monitored continuously using brain monitoring software ICM+®,) Pressure reactivity index (PRx) and 'Optimal CPP' (CPPopt) were calculated. Patient outcome was dichotomized into survivors and non-survivors.
Results:
At 6 months 8/12 (66%) of the cohort survived the TBI. The median (±IQR) ICP was significantly lower in survivors 13.1±3.2 mm Hg compared to non-survivors 21.6±42.9 mm Hg (p = 0.003). The median time spent with ICP over 20 mm Hg was lower in survivors (9.7+9.8% vs 60.5+67.4% in non-survivors; p = 0.003). Although there was no evidence that CPP was different between survival groups, the time spent with a CPP close (within 10 mm Hg) to the optimal CPP was significantly longer in survivors (90.7±12.6%) compared with non-survivors (70.6±21.8%; p = 0.02). PRx provided significant outcome separation with median PRx in survivors being 0.02±0.19 compared to 0.39±0.62 in non-survivors (p = 0.02).
Conclusion:
Our observations provide evidence that multi-modality monitoring may be useful in pediatric TBI with ICP, deviation of CPP from CPPopt, and PRx correlating with patient outcome.
