Intervention thresholds of intracranial pressure and cerebral perfusion pressure in children with severe traumatic brain injury

Xiaobing CHEN; Lei ZHANG; Xueling ZHAO; Ping LIANG; Xuan ZHAI; Lusheng LI; Yudong ZHOU; Jianjun ZHOU; Wenyuan JI

doi:10.16016/j.1000-5404.202007043

您当前的位置：

首页 >

文章列表页 >

Intervention thresholds of intracranial pressure and cerebral perfusion pressure in children with severe traumatic brain injury

Pediatric Clinical reseach | 更新时间：2026-01-09

- Intervention thresholds of intracranial pressure and cerebral perfusion pressure in children with severe traumatic brain injury
- Journal of Third Military Medical University Vol. 42, Issue 22, Pages: 2167-2175(2020)
- 作者机构：
  
  1.400014 重庆，重庆医科大学附属儿童医院神经外科，国家儿童健康与疾病临床医学研究中心，儿童发育疾病研究教育部重点实验室，儿科学重庆市重点实验室
  2.401120 重庆，重庆医科大学附属第三医院(捷尔医院)神经疾病中心
- 作者简介：
- 基金信息：
  
  the Key Project of National Clinical Keydiscipline Construction Programs of China(国卫办医函〔2013〕544);the Key Project of Chongqing Municipal Health and Family Planning Commission(2015ZDXM016)
- DOI：10.16016/j.1000-5404.202007043
  CLC： R181.32;R726.511;R740.4
- Received：06 July 2020，
  
  Revised：2020-08-08，
  
  Published：30 November 2020
- 稿件说明：
移动端阅览
Xiaobing CHEN, Lei ZHANG, Xueling ZHAO, et al. Intervention thresholds of intracranial pressure and cerebral perfusion pressure in children with severe traumatic brain injury[J]. Journal of Third Military Medical University, 2020, 42(22): 2167-2175.
DOI：

Xiaobing CHEN, Lei ZHANG, Xueling ZHAO, et al. Intervention thresholds of intracranial pressure and cerebral perfusion pressure in children with severe traumatic brain injury[J]. Journal of Third Military Medical University, 2020, 42(22): 2167-2175. DOI： 10.16016/j.1000-5404.202007043.

摘要

目的

研究儿童重型创伤性脑损伤(severe traumatic brain injury

STBI)颅内压及脑灌注压的临床特点及治疗阈值。

方法

前瞻性研究2014年6月至2018年6月重庆医科大学附属儿童医院神经外科收治的STBI患儿，术后每小时监测患儿颅内压和动脉血压。根据文献报道，预估不同年龄组患儿的理论颅内压和脑灌注压阈值，分别计算患儿各阈值的压力时间指数(pressure-time index，PTI)。采用受试者工作特征曲线(ROC)评估PTI的预测能力，根据各个年龄组患儿在不同理论阈值水平时的PTI值与伤后6个月时的GOS评分，计算ROC曲线下面积(area under curve

AUC)，取最大AUC相应的理论颅内压和脑灌注压阈值作为该年龄组患儿的颅内压和脑灌注压治疗阈值。

结果

本研究共纳入STBI患儿115例，< 2岁组25例，2~7岁组52例，＞7岁组38例。年龄相关的颅内压阈值: < 2岁组为14.4 mmHg，2~7岁组为20.0 mmHg，＞7岁组为21.6 mmHg；年龄相关的脑灌注压阈值: < 2岁组为45.0 mmHg，2~7岁组为55.0 mmHg，＞7岁组为55.0 mmHg。

结论

不同年龄阶段的STBI患儿的颅内压和脑灌注压治疗阈值不同，推荐儿童重型TBI颅内压治疗阈值: < 2岁为14.4 mmHg，2~7岁为20.0 mmHg，＞7岁为21.6 mmHg；脑灌注压治疗阈值: < 2岁为45.0 mmHg，≥2岁为55.0 mmHg。

Abstract

Objective

To analyze the clinical characteristics of changes in intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and determine their intervention thresholds in children with severe traumatic brain injury (STBI).

Methods

This prospective observational study was conducted among the children with STBI admitted in the Children's Hospital of Chongqing Medical University between June

2014 and June 2018. ICP and CPP of the children were dynamically monitored at every hour after the operation. The theoretical thresholds of ICP and CPP were adopted from literature

and the pressure-time indexes (PTIs) for these thresholds were calculated and their predictive ability was assessed using the receiver operating characteristic (ROC) curve. For children in different age groups (< 2 years

2-7 years and >7 years)

the area under the ROC curve (AUC) was calculated according to the PTIs for each theoretical threshold and Glasgow Outcome Scale score at 6 months after the trauma. The theoretical thresholds corresponding to the maximum AUC was determined to be the optimal thresholds.

Results

A total of 115 children with STBI were included in this study. For children aged < 2 years (25 cases)

2-7 years (52 cases) and >7 years (38 cases)

the age-specific thresholds of ICP was 14.4

20.0 and 21.6 mmHg

and those of CPP was 45.0

55.0 and 55.0 mmHg respectively.

Conclusion

The intervention thresholds of ICP and CPP differ among the STBI chidren at different ages. In children with STBI aged < 2 years

2-7 years and >7 years

we recommend postoperative ICP of 14.4

20.0 and 21.6 mmHg

and CCP of 45.0

55.0 and 55.0 mmHg respectively

as the thresholds for initiating interventions.

关键词

Keywords

references

LOVETT M E, O'BRIEN N F, LEONARD J R. Children with severe traumatic brain injury, intracranial pressure, cerebral perfusion pressure, what does it mean? A review of the literature[J]. Pediatr Neurol, 2019, 94: 3-20. DOI: 10.1016/j.pediatrneurol.2018.12.003.

BENNETT T D, MARSH R, MAERTENS J A, et al . Decision- making about intracranial pressure monitor placement in children with traumatic brain injury[J ] . Pediatr Crit Care Med, 2019, 20(7): 645-651. DOI: 10.1097/pcc.00000000 00001934.

张雷, 梁平, 翟瑄, 等.儿童颅脑创伤后颅内压及脑灌注压的临床特点[J].中华创伤杂志, 2014, 30(10): 995-999. DOI:10.3760/cma.j.issn.1001-8050.2014.10.007.

ZHANG L, LIANG P, ZHAI X, et al . Clinical features of intracranial pressure and cerebral perfusion pressure after craniocerebral trauma in children[J ] . Chin J Trauma , 2014, 30(10): 995-999. DOI:10.3760/cma.j.issn.1001-8050.2014.10.007.

CARNEY N A, CHESNUT R, KOCHANEK P M. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents[J]. Pediatr Crit Care Med, 2003, 4(supplement): S1. DOI: 10.1097/01.ccm.0000067635.95882.24.

中国医师协会神经外科医师分会, 中国神经创伤专家委员会.中国颅脑创伤外科手术指南[J].中华神经外科杂志, 2015, 25(1): 100-101. DOI:10.3877/cma.j.issn.2095-9141.2015.01.018.

Neurosurgeons Branch of Chinese Medical Doctors Association, China Neurotrauma Expert Committee.Guidelines for the surgical management of traumatic brain injury in China[J]. Chin J Neurosurg(Electron Ed), 2015, 25(1): 100-101. DOI:10.3877/cma.j.issn.2095-9141.2015.01.018.

MILLER FERGUSON N, SHEIN S L, KOCHANEK P M, et al . Intracranial hypertension and cerebral hypoperfusion in children with severe traumatic brain injury: thresholds and burden in accidental and abusive insults[J ] . Pediatr Crit Care Med, 2016, 17(5): 444-450. DOI: 10.1097/PCC.0000000000000709.

CHAMBERS I R, JONES P A, LO T Y M, et al . Critical thresholds of intracranial pressure and cerebral perfusion pressure related to age in paediatric head injury[J ] . J Neurol Neurosurg Psychiatry, 2006, 77(2): 234-240. DOI: 10 .1136/jnnp.2005.072215.

JAGANNATHAN J, OKONKWO D O, YEOH H K, et al . Long-term outcomes and prognostic factors in pediatric patients with severe traumatic brain injury and elevated intra-cranial pressure[J ] . J Neurosurg Pediatr, 2008, 2(4): 240-249. DOI: 10.3171/ped.2008.2.10.240.

MILES D K, PONISIO M R, COLVIN R, et al . Predictors of intracranial hypertension in children undergoing ICP monitoring after severe traumatic brain injury[J ] . Childs Nerv Syst, 2020, 36(7): 1453-1460. DOI: 10.1007/s00381-020-04516-7.

KOCHANEK P M, TASKER R C, CARNEY N, et al . Guidelines for the management of pediatric severe traumatic brain injury, third edition[J ] . Pediatr Crit Care Med, 2019, 20(3): 280-289. DOI: 10.1097/pcc.0000000000 001736.

GRINKEVICIŪTE D E, KEVALAS R, MATUKEVICIUS A, et al . Significance of intracranial pressure and cerebral perfusion pressure in severe pediatric traumatic brain injury[J ] . Medicina (Kaunas), 2008, 44(2): 119-125.

CARNEY N, TOTTEN A M, O'REILLY C, et al . Guidelines for the management of severe traumatic brain injury, four th edition[J ] . Neurosurgery, 2017, 80(1): 6-15. DOI: 10.1227/neu.0000000000001432.

ZEILER F A, ERCOLE A, CABELEIRA M, et al . Patient-specific ICP epidemiologic thresholds in adult traumatic brain injury[J ] . J Neurosurg Anesthesiol, 2019. DOI: 10.1097/ANA.0000000000000616.Online ahead of print.

吴翔, 高国一, 冯军峰, 等.颅脑创伤患者颅内压相关参数与预后关系的研究[J].中华神经外科杂志, 2018, 34(2): 119-123. DOI: 10.3760/cma.j.issn.1001-2346.2018.02.003.

WU X, GAO G Y, FENG J F, et al . Analysis of correlation between intracranial pressure and outcome in traumatic brain injury patients[J ] . Chin J Neurosurg, 2018, 34(2): 119-123. DOI: 10.3760/cma.j.issn.1001-2346.2018.02.003.

MYBURGH J A. Intracranial pressure thresholds in severe traumatic brain injury: Pro[J]. Intens Care Med, 2018, 44(8): 1315-1317. DOI: 10.1007/s00134-018-5264-z.

符跃强, 许峰.儿童创伤性颅内高压治疗进展[J].中华实用儿科临床杂志, 2013, 28(24): 1912-1914.

FU Y Q, XU F. Progress in treatment of traumatic intra-cranial hypertension in children[J]. Chin J Appl Clin Pediatr, 2013, 28(24): 1912-1914.

ADELSON P D, RAGHEB J, KANEV P, et al . Phase Ⅱ clinical trial of moderate hypothermia after severe traumatic brain injury in children[J ] . Neurosurgery, 2005, 56(4): 740-754. DOI: 10.1227/01.neu.0000156471.50726.26.

MEHTA A, KOCHANEK P M, TYLERKABARA E C, et al . Relationship of intracranial pressure and cerebral perfusion pressure with outcome in young children after severe traumatic brain injury[J ] . Dev Neurosci, 2010, 32: 413-419. DOI: 10.1159/000316804.

SORRENTINO E, DIEDLER J, KASPROWICZ M, et al . Critical thresholds for cerebrovascular reactivity after traumatic brain injury[J ] . Neurocrit Care, 2012, 16(2): 258-266. DOI: 10.1007/s12028-011-9630-8.

GVIZA F, MEYFROIDT G, PIPER I, et al . Cerebral perfusion pressure insults and associations with outcome in adult traumatic brain injury[J ] . J Neurotrauma, 2017, 34(16): 2425-2431. DOI: 10.1089/neu.2016.4807.

LIN J W, TSAI J T, LIN C M, et al . Evaluation of optimal cerebral perfusion pressure in severe traumatic brain injury[J ] . Acta Neurochir Suppl, 2008, 101: 131-136. DOI: 10.1007/978-3-211-78205-7_22.

FIGAJI A A, ZWANE E, THOMPSON C, et al . Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury. Part 2: Relationship with clinical, physiological, and treatment factors[J ] . Childs Nerv Syst, 2009, 25(10): 1335-1343. DOI: 10.1007/s00381-009-0821-y.

CHAIWAT O, SHARMA D, UDOMPHORN Y, et al . Cerebral hemodynamic predictors of poor 6-month Glasgow Outcome Score in severe pediatric traumatic brain injury[J ] . J Neurotrauma, 2009, 26(5): 657-663. DOI: 10.1089/neu.2008.0770.

ALLEN B B, CHIU Y, GERBER L M, et al . Age-specific cerebral perfusion pressure thresholds and survival in children and adolescents with severe traumatic brain injury[J ] . Pediatr Crit Care Med, 2014, 15(1): 62-70. DOI: 10.1097/PCC.0b013e3182a556ea.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Study on age-related normal intracranial pressure and cerebral perfusion pressure thresholds in children

Intracranial pressure monitoring guides the dose of propofol in anesthesia for craniocerebral trauma patients

Perioperative monitoring of intracranial pressure in 29 children with hydrocephalus and its clinical significance

Safe and effective concentration of ropivacaine in interscalene brachial plexus block for children aged 6 to 10 years: a sequential allocation study

Related Author

陈小兵

纪文元

梁平

翟瑄

周建军

程杨

赵雪灵

Peng YUAN

Related Institution

Department of Neurosurgery, Emergency Medical Center of Chongqing

Department of Anesthesiology, Jilin Provincial Hospital of Traditional Chinese and Western Medicine

Department of Anesthesiology, Southwest Hospital, Third Military Medical University

Department of Neurosugery，National Clinical Research Center for Child Health and Disorders ，Key Laboratory of Child Development and Disorders of Ministry of Education ，Chongqing Key Laboratory of Pediatrics ，Children’s Hospital of Chongqing Medical University

Department of Anesthesiology Children’s Hospital of Chongqing Medical University， National Clinical Research Center for Child Health and Disorders， Ministry of Education Key Laboratory of Child Development and Disorders， Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders

⁰