Related Experiment Videos
Intracranial pressure and cerebral perfusion pressure in near-drowning
Insights
Strict control of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in near-drowning pediatric patients did not guarantee survival. Late intracranial hypertension may indicate severe neurological damage rather than cause it.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Emergency medicine
Background:
- Near-drowning incidents in children pose significant risks for neurological injury.
- Managing intracranial pressure (ICP) and cerebral perfusion pressure (CPP) is crucial for improving outcomes in severe pediatric cases.
Purpose of the Study:
- To investigate the relationship between ICP/CPP management and patient outcomes in pediatric near-drowning.
- To determine if early ICP/CPP control influences survival and neurological recovery.
Main Methods:
- Eleven pediatric near-drowning victims were monitored.
- Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were strictly controlled.
- Patients were categorized into three outcome groups: complete recovery, persistent vegetative state, and death.
Main Results:
- Cerebral perfusion pressure (CPP) remained above 50 mm Hg in all patients during the early post-immersion phase (first 72 hours).
- Occasional, manageable intracranial pressure (ICP) spikes above 15 mm Hg occurred in all outcome groups.
- Repeated ICP elevations were primarily observed after 72 hours in patients with adverse outcomes.
Conclusions:
- Strict control of ICP and CPP in the early phase did not ensure favorable neurological outcomes.
- Sustained intracranial hypertension developing later in the course suggests a severe underlying neurological insult.
- The findings indicate that late intracranial hypertension is a marker, not a cause, of poor neurological outcome in pediatric near-drowning.
Abstract:
Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were strictly controlled in 11 pediatric victims of near-drowning. Three outcome groups were defined: complete recovery, persistent vegetative state, and death. In the early postimmersion phase (first 72 h), CPP was consistently above 50 mm Hg in all patients. There were occasional, nonrepetitive, and easily controllable ICP spikes above 15 mm Hg in three patients from each group. Repeated ICP spikes above 15 mm Hg were observed in some patients with adverse outcome only after 72 h. Successful control of ICP and CPP did not ensure intact survival, and sustained late intracranial hypertension is more likely a sign of profound neurologic insult rather than its cause.