Events associated with the occurrence of intracranial hypertension in pediatric patients with severe cranioencephalic trauma and monitoring of intracranial pressure

被引:0
作者
Guerra, Sergio Diniz [1 ]
Ferreira, Alexandre Rodrigues [2 ]
机构
[1] Fundacao Hosp Estado Minas Gerais, Belo Horizonte, MG, Brazil
[2] Univ Fed Minas Gerais, Belo Horizonte, MG, Brazil
关键词
Head traumas; Intracranial pressure; Intracranial hypertension; Critical care; Child; Adolescent; CEREBRAL PERFUSION-PRESSURE; BRAIN-INJURY; CHILDREN; MANAGEMENT; TRIAL; COSTS; US;
D O I
10.1590/1984-0462/2020/38/2019123
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective: To determine the events associated with the occurrence of intracranial hypertension (ICH) in pediatric patients with severe cranioencephalic trauma. Methods: This was a prospective cohort study of patients 18 years old and younger with cranioencephalic trauma, scores below nine on the Glasgow Coma Scale, and intracranial pressure monitoring. They were admitted between September, 2005 and March, 2014 into a Pediatric Intensive Care Unit. ICH was defined as an episode of intracranial pressure above 20 mmHg for more than five minutes that needed treatment. Results: A total of 198 children and adolescents were included in the study, of which 70.2% were males and there was a median age of nine years old. ICH occurred in 135 (68.2%) patients and maximum intracranial pressure was 36.3 mmHg, with a median of 34 mmHg. A total of 133 (97.8%) patients with ICH received sedation and analgesia for treatment of the condition, 108 (79.4%) received neuromuscular blockers, 7 (5.2%) had cerebrospinal fluid drainage, 105 (77.2%) received mannitol, 96 (70.6%) received hyperventilation, 64 (47.1%) received 3% saline solution, 20 (14.7%) received barbiturates, and 43 (31.9%) underwent a decompressive craniectomy. The events associated with the occurrence of ICH were tomographic findings at the time of admission of diffuse or hemispheric swelling (edema plus engorgement). The odds ratio for ICH in patients with Marshall III (diffuse swelling) tomography was 14 (95%CI 2.8-113; p<0.003), and for those with Marshall IV (hemispherical swelling) was 24.9 (95%CI 2.4-676, p<0.018). Mortality was 22.2%. Conclusions: Pediatric patients with severe cranioencephalic trauma and tomographic alterations of Marshall III and IV presented a high chance of developing ICH.
引用
收藏
页数:7
相关论文
共 29 条
[1]  
Adelson P David, 2003, Pediatr Crit Care Med, V4, pS65
[2]   Intracranial Pressure Monitoring in Children With Severe Traumatic Brain Injury National Trauma Data Bank-Based Review of Outcomes [J].
Alkhoury, Fuad ;
Kyriakides, Tassos C. .
JAMA SURGERY, 2014, 149 (06) :544-548
[3]  
[Anonymous], ADV TRAUM LIF SUPP D
[4]  
[Anonymous], WORLD HLTH REP 2008
[5]   Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury [J].
Balestreri, Marcella ;
Czosnyka, Marek ;
Hutchinson, Peter ;
Steiner, Luzius A. ;
Hiler, Magda ;
Smielewski, Piotr ;
Pickard, John D. .
NEUROCRITICAL CARE, 2006, 4 (01) :8-13
[6]   Functional Outcome After Intracranial Pressure Monitoring for Children With Severe Traumatic Brain Injury [J].
Bennett, Tellen D. ;
DeWitt, Peter E. ;
Greene, Tom H. ;
Srivastava, Rajendu ;
Riva-Cambrin, Jay ;
Nance, Michael L. ;
Bratton, Susan L. ;
Runyan, Desmond K. ;
Dean, J. Michael ;
Keenan, Heather T. .
JAMA PEDIATRICS, 2017, 171 (10) :965-971
[7]   What Do Severe Traumatic Brain Injury Acute Costs Tell Us About Value? Currently Inconclusive [J].
Bratton, Susan L. ;
Bennett, Kimberly Statler .
PEDIATRIC CRITICAL CARE MEDICINE, 2016, 17 (05) :467-468
[8]   Guidelines for the Management of Severe Traumatic Brain Injury: Editor's commentary [J].
Bullock, M. Ross ;
Povlishock, John T. .
JOURNAL OF NEUROTRAUMA, 2007, 24 :VII-VIII
[9]   A Consensus-Based Interpretation of the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure Trial [J].
Chesnut, Randall M. ;
Bleck, Thomas P. ;
Citerio, Giuseppe ;
Classen, Jan ;
Cooper, D. James ;
Coplin, William M. ;
Diringer, Michael N. ;
Graende, Per-Olof ;
Hemphill, J. Claude, III ;
Hutchinson, Peter J. ;
Le Roux, Peter ;
Mayer, Stephan A. ;
Menon, David K. ;
Myburgh, John A. ;
Okonkwo, David O. ;
Robertson, Claudia S. ;
Sahuquillo, Juan ;
Stocchetti, Nino ;
Sung, Gene ;
Temkin, Nancy ;
Vespa, Paul M. ;
Videtta, Walter ;
Yonas, Howard .
JOURNAL OF NEUROTRAUMA, 2015, 32 (22) :1722-1724
[10]   A Trial of Intracranial-Pressure Monitoring in Traumatic Brain Injury [J].
Chesnut, Randall M. ;
Temkin, Nancy ;
Carney, Nancy ;
Dikmen, Sureyya ;
Rondina, Carlos ;
Videtta, Walter ;
Petroni, Gustavo ;
Lujan, Silvia ;
Pridgeon, Jim ;
Barber, Jason ;
Machamer, Joan ;
Chaddock, Kelley ;
Celix, Juanita M. ;
Cherner, Marianna ;
Hendrix, Terence .
NEW ENGLAND JOURNAL OF MEDICINE, 2012, 367 (26) :2471-2481