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Catheter-associated deep vein thrombosis in children with severe traumatic brain injury: A single-center experience
Marlina E Lovett1, Megan Daniel1, Rohali Keesari2
1Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA.
Insights
Deep vein thrombosis (DVT) is common in children with severe traumatic brain injury (sTBI). Prolonged mechanical ventilation, not central venous lines or hypertonic saline, was associated with DVT in this pediatric study.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Vascular medicine
Background:
- Severe traumatic brain injury (sTBI) in children often requires mechanical ventilation and central venous lines (CVLs).
- Deep vein thrombosis (DVT) is a potential complication in critically ill pediatric patients.
Purpose of the Study:
- To describe the incidence of DVT in mechanically ventilated children with sTBI and a CVL.
- To identify modifiable risk factors for DVT in this population, specifically central venous line duration and hypertonic saline (HTS) use.
Main Methods:
- Retrospective study of 77 children (0-18 years) with sTBI, mechanical ventilation, and CVL.
- Analysis of DVT presence, CVL duration, mechanical ventilation duration, and hypertonic saline (3% equivalent ml/kg) use.
- Univariable and multivariable logistic regression to identify DVT risk factors.
Main Results:
- A high incidence of extremity DVT was detected in 29.9% of the children.
- Univariable analysis showed prolonged CVL use and mechanical ventilation duration were associated with DVT.
- Multivariable analysis identified only mechanical ventilation duration as a significant risk factor for DVT.
Conclusions:
- Extremity DVT is a significant concern in pediatric patients with sTBI requiring mechanical ventilation and CVLs.
- Mechanical ventilation duration, but not CVL duration or HTS use, is associated with DVT in this cohort.
Background:
This study was performed to describe the single-center experience of deep vein thrombosis (DVT) in children with severe traumatic brain injury (sTBI) who were mechanically ventilated with a central line, and to identify potentially modifiable risk factors. It was hypothesized that children with DVT would have a longer duration of central venous line (CVL) and a higher use of hypertonic saline (HTS) compared to those without DVT.
Procedure/Methods:
This was a retrospective study of children (0-18 years) with sTBI, who were intubated, had a CVL, and a minimum intensive care unit (ICU) stay of 3 days. Children were analyzed by the presence or absence of DVT. HTS use was evaluated using milliliter per kilogram (ml/kg) of 3% equivalents. Univariable and multivariable logistic regression models were used to determine which factors were associated with DVT.
Results:
Seventy-seven children met inclusion criteria, 23 (29.9%) had a DVT detected in an extremity. On univariable analysis, children with DVT identified in an extremity had prolonged CVL use (14 vs. 8.5 days, p = .021) and longer duration of mechanical ventilation (15 vs. 10 days, p = .013). HTS 3% equivalent ml/kg was not different between groups. On multivariable analysis, mechanical ventilation duration was associated with DVT detection in an extremity, whereas neither CVL duration nor HTS use had an association.
Conclusions:
There was a high incidence of extremity DVT detected in children with sTBI who received invasive mechanical ventilation and had a CVL. HTS administration was not associated with DVT detection in an extremity.
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