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Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury

Part 1: Relationship with outcome

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Abstract

Introduction

Intracranial pressure (ICP) monitoring and cerebral perfusion pressure (CPP) management are the current standards to guide care of severe traumatic brain injury (TBI). However, brain hypoxia and secondary brain injury can occur despite optimal ICP and CPP. In this study, we used brain tissue oxygen tension (PbtO2) monitoring to examine the association between multiple patient factors, including PbtO2, and outcome in pediatric severe TBI.

Materials and methods

In this prospective observational study, 52 children (less than 15 years) with severe TBI were managed with continuous PbtO2 and ICP monitoring. The relationships between outcome [Glasgow Outcome Score (GOS) and Pediatric Cerebral Performance Category Scale] and clinical, radiologic, treatment, and physiological variables, including PbtO2, were examined using multiple logistic regression analysis.

Results

Outcome was favorable in 40 patients (77%) and unfavorable (mortality, 9.6%; n = 5) in 12 (23%). In univariate analysis, the following variables had a significant association with unfavorable outcome: initial GCS, computed tomography classification, ICPpeak, mICP24, mICP, CPPlow, CPP<40, pupil reactivity, \({\text{PbtO}}_{2_{{\text{low}}} } \), PbtO2 < 5 mmHg, PbtO2 < 10 mmHg, \({\text{mPbtO}}_{{\text{2}}_{{\text{24}}} } \), and time–severity product. PbtO2 parameters had the strongest independent association with poor outcome in multiple regression analysis. In particular, when PbtO2 was <5 mmHg for >1 h, the adjusted OR for poor outcome was 27.4 (95% confidence interval, 1.9–391). No variables apart from PbtO2 were independently associated with mortality when controlled for PbtO2.

Conclusion

Reduced PbtO2 is shown to be an independent factor associated with poor outcome in pediatric severe TBI in the largest study to date. It appears to have a stronger association with outcome than conventionally evaluated measures.

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Acknowledgements

Dr Figaji has received a grant from the South African–Swedish Links Programme (SIDA, National Research Foundation). Drs Figaji and Le Roux have also received a grant from the Integra Foundation for the study of cerebral perfusion pressure thresholds in children.

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Authors and Affiliations

  1. Divisions of Neurosurgery, School of Child and Adolescent Health, University of Cape Town, Red Cross Children’s Hospital, Cape Town, South Africa

    Anthony A. Figaji, Crispin Thompson, A. Graham Fieggen & Jonathan C. Peter

  2. Infectious Disease Epidemiology Unit (Biostatistics), School of Public Health and Family Medicine, Falmouth Building, University of Cape Town, Cape Town, South Africa

    Eugene Zwane

  3. Pediatric Critical Care, School of Child and Adolescent Health, University of Cape Town, Red Cross Children’s Hospital, Cape Town, South Africa

    Andrew C. Argent

  4. Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, 19107, PA, USA

    Peter D. Le Roux

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  1. Anthony A. Figaji
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  2. Eugene Zwane
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Correspondence to Anthony A. Figaji.

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Figaji, A.A., Zwane, E., Thompson, C. et al. Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury. Childs Nerv Syst 25, 1325–1333 (2009). https://doi.org/10.1007/s00381-009-0822-x

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  • DOI: https://doi.org/10.1007/s00381-009-0822-x

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