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Intracranial pressure monitoring in severe pediatric near-drowning
Insights
Near-drowned children with elevated intracranial pressure (ICP) have poor outcomes. Normal ICP monitoring in near-drowning cases indicates a significantly better salvage rate, highlighting ICP
Area of Science:
- Pediatric critical care medicine
- Neurology
- Emergency medicine
Background:
- Near-drowning incidents in children can lead to severe neurological injury.
- Intracranial pressure (ICP) is a critical indicator of brain health following hypoxic-ischemic events.
- Effective management strategies for near-drowned children are crucial for improving survival and neurological outcomes.
Purpose of the Study:
- To investigate the relationship between intracranial pressure (ICP) levels and outcomes in pediatric near-drowning patients.
- To determine the prognostic value of ICP monitoring in near-drowning resuscitation.
- To assess the efficacy of brain resuscitative therapy in managing elevated ICP.
Main Methods:
- Prospective study of 20 near-drowned children with Glasgow Coma Scale score of 3.
- Continuous intracranial pressure (ICP) monitoring.
- Implementation of brain resuscitative therapy.
- Analysis of ICP trends and patient outcomes, including mortality and neurological status.
Main Results:
- 14 out of 20 patients developed elevated ICP (>20 torr) by day 3; 11 had sustained intracranial hypertension (>30 torr).
- 10 children with elevated ICP died, and 4 remained in a persistent vegetative state.
- Of 6 patients with ICP never exceeding 20 torr, 3 recovered completely, 1 died, and 2 had no cognitive function.
- Elevated ICP was significantly associated with poor outcomes (P = 0.017).
Conclusions:
- Intracranial hypertension in near-drowned children is linked to uniformly poor outcomes.
- Normal ICP levels correlate with a significantly better salvage rate.
- ICP monitoring is vital for predicting neurological damage and guiding treatment in pediatric near-drowning cases.
Abstract:
Between April 1979 and April 1981, 20 near-drowned children admitted to Childrens Hospital of Los Angeles with a Glasgow coma score of 3 underwent intracranial pressure (ICP) monitoring and brain resuscitative therapy. By the 3rd hospital day, 14 patients had developed ICP elevation above 20 torr, and 11 of these had sustained intracranial hypertension above 30 torr. Ten of these children died, and 4 remain in a persistent vegetative state. Of 6 patients whose ICP never exceeded 20 torr, 3 recovered completely, 1 died, and 2 remain without any cognitive function. The salvage rate for patients with normal ICP after near-drowning accidents is significantly better than that for patients in whom the ICP is elevated (P = 0.017). Intracranial hypertension is associated with a uniformly bad outcome and is frequent in patients who die or suffer permanent, severe central nervous system damage after near-drowning.