Jing Junjie,Zhao Qingshuang,Ying Jianbin,et al.Application of ventricular type intracranial pressure monitoring in children with severe brain injury at different ages[J].Journal of Clinical Pediatric Surgery,,22():956-960.[doi:10.3760/cma.j.cn101785-202206021-010]
Application of ventricular type intracranial pressure monitoring in children with severe brain injury at different ages
- Keywords:
- Intracranial Pressure Monitoring; Brain Injuries; Child
- Abstract:
-
Objective To explore the application outcomes of ventricular intracranial pressure (ICP) monitoring at different ages and explore its role in the treatment of severe brain injury in children.Methods From June 2017 to March 2022,retrospective review was performed for 26 children with severe brain injury.ICP was successfully monitored.With a male-to-female ratio of 16∶10,they had an average age of 1.3 years (37 days to 6 years).Based upon age,they were assigned into two groups of infant aged under 1 year (n=15) and (1-6) year (n=11).Ventricular type ICP monitoring electrode (Codman) was implanted into lateral ventricles and cerebrospinal fluid (CSF) continuously drained.GCS score,ICP and CSF drainage were observed at pre-op and Day 1/3/7/14 post-op.Results The overall mortality rate was 11.5%.Two cases died early post-op and another one pausing treatment passed away at Day 2 post-discharge.No statistically significant inter-group difference existed in Glasgow coma scale (GCS) score (P=0.235).The overall ICP was lower in infant group than that in (1-6) year group (P=0.09).Drainage volume of CSF was also lower than that in (1-6) year group (P<0.001).However,there was no interaction between group and time.Statistical significance existed in GCS scores at different timepoints within each group (P<0.001).GCS scores of infant and (1-6) year groups at pre-op (7.31±0.85; 6.40±1.43)
P<0.001).That is,intra-op (26.00±4.00; 30.70±3.74) >post-op Day 1 (20.38±4.35; 22.10±3.98) >post-op Day 3 (15.77±4.19; 19.60±4.58) >post-op Day 7 (10.54±1.61; 14.10±3.63) >post-op Day 14 (6.31±1.18; 8.40±1.35).The difference in drainage volume of CSF (ml) at each timepoint was also statistically significant (P<0.001).That is,post-op Day 1 (51.54±14.91; 97.20±23.30) Conclusion After severe brain injury in children,ventricular ICP monitoring was applied.The postoperative prognosis of infants and (1-6) year groups was basically comparable.With a gradual rise of CSF drainage,ICP declined and GCS score spiked.It peaked at Day 14 post-op.
References:
[1] Tilford JM,Simpson PM,Yeh TS,et al.Variation in therapy and outcome for pediatric head trauma patients[J].Crit Care Med,2001,29(5):1056-1061.DOI:10.1097/00003246-200105000-00037.
[2] Bennett TD,Riva-Cambrin J,Keenan HT,et al.Variation in intracranial pressure monitoring and outcomes in pediatric traumatic brain injury[J].Arch Pediatr Adolesc Med,2012,166(7):641-647.DOI:10.1001/archpediatrics.2012.322.
[3] Bennett TD,DeWitt PE,Greene TH,et al.Functional outcome after intracranial pressure monitoring for children with severe traumatic brain injury[J].JAMA Pediatr,2017,171(10):965-971.DOI:10.1001/jamapediatrics.2017.2127.
[4] Kochanek PM,Tasker RC,Bell MJ,et al.Management of pediatric severe traumatic brain injury:2019 consensus and guidelines-based algorithm for first and second tier therapies[J].Pediatr Crit Care Med,2019,20(3):269-279.DOI:10.1097/PCC.0000000000001737.
[5] Kochanek PM,Tasker RC,Carney N,et al.Guidelines for the management of pediatric severe traumatic brain injury,third edition:update of the brain trauma foundation guidelines,executive summary[J].Neurosurgery,2019,84(6):1169-1178.DOI:10.1093/neuros/nyz051.
[6] Carney N,Totten AM,O’Reilly C,et al.Guidelines for the management of severe traumatic brain injury,fourth edition[J].Neurosurgery,2017,80(1):6-15.DOI:10.1227/NEU.0000000000001432.
[7] Alkhoury F,Kyriakides TC.Intracranial pressure monitoring in children with severe traumatic brain injury:national trauma data bank-based review of outcomes[J].JAMA Surg,2014,149(6):544-548.DOI:10.1001/jamasurg.2013.4329.
[8] Delaplain PT,Grigorian A,Lekawa M,et al.Intracranial pressure monitoring associated with increased mortality in pediatric brain injuries[J].Pediatr Surg Int,2020,36(3):391-398.DOI:10.1007/s00383-020-04618-y.
[9] de Andrade AF,Paiva WS,de Amorim RLO,et al.Continuous ventricular cerebrospinal fluid drainage with intracranial pressure monitoring for management of posttraumatic diffuse brain swelling[J].Arq Neuropsiquiatr,2011,69(1):79-84.DOI:10.1590/s0004-282x2011000100016.
[10] Chau CYC,Craven CL,Rubiano AM,et al.The evolution of the role of external ventricular drainage in traumatic brain injury[J].J Clin Med,2019,8(9):1422.DOI:10.3390/jcm8091422.
[11] Shapiro K,Marmarou A.Clinical applications of the pressure-volume index in treatment of pediatric head injuries[J].J Neurosurg,1982,56(6):819-825.DOI:10.3171/jns.1982.56.6.0819.
[12] Woods KS,Horvat CM,Kantawala S,et al.Intracranial and cerebral perfusion pressure thresholds associated with inhospital mortality across pediatric neurocritical care[J].Pediatr Crit Care Med,2021,22(2):135-146.DOI:10.1097/PCC.0000000000002618.
[13] Gargadennec T,Ferraro G,Chapusette R,et al.Detection of cerebral hypoperfusion with a dynamic hyperoxia test using brain oxygenation pressure monitoring[J].Crit Care,2022,26(1):35.DOI:10.1186/s13054-022-03918-0.
[14] Baker WB,Balu R,He L,et al.Continuous non-invasive optical monitoring of cerebral blood flow and oxidative metabolism after acute brain injury[J].J Cereb Blood Flow Metab,2019,39(8):1469-1485.DOI:10.1177/0271678X19846657.
[15] Ruzas CM,DeWitt PE,Bennett KS,et al.EEG monitoring and antiepileptic drugs in children with severe TBI[J].Neurocrit Care,2017,26(2):256-266.DOI:10.1007/s12028-016-0329-8.
Memo
收稿日期:2022-6-8。
基金项目:福建省省级临床重点专科建设项目-福建省儿童医院小儿神经外科[闽卫医政(2023)1163号]
通讯作者:宋云海,Email:Songyunhai3021@126.com