Artikel
Clinical course and outcome of 40 children with severe head injury
Kritische Parameter bei Kindern mit schwerem Schädel-Hirn-Trauma
Suche in Medline nach
Autoren
-
A. Sarrafzadeh
- Department of Neurosurgery, Charité Campus Virchow-Medical Clinic, Humboldt-University Berlin
-
H. Haberl
- Department of Neurosurgery, Charité Campus Virchow-Medical Clinic, Humboldt-University Berlin
| Veröffentlicht: | 4. Mai 2005 |
|---|
Gliederung
Text
Objective
Head injury is a major cause of death and disability in children. Despite advances in resuscitation and intensive care monitoring, there are few data demonstrating the predictive value of certain physiological variables regarding outcome in this patient population. The purpose of the study was to analyze the clinical course and physiological variables such as cerebral perfusion pressure, oxygenation parameters and cerebral metabolism in relation to surgical interventions (e.g. decompressive surgery) and clinical outcome.
Methods
Retrospective study, setting in a neurosurgical intensive care unit. 40 children (mean age 9.5, range 5-16 years) with severe head injury and intracranial pressure monitoring, whose admission Glasgow Coma Scores (GCS) were <8. After admission to the intensive care unit, the following parameters were monitored: mean arterial blood pressure, cerebral perfusion pressure, endtidal CO2, and the GCS. In a subgroup of patients (n=10) brain tissue pO2 (btiO2, Licox) and/or microdialysis was monitored. Hourly analyses of glucose, pyruvate, lactate and glutamate were performed using a bedside device (CMA 600). Outcome was assessed after one year according to the Glasgow Outcome Scale. Admission data and physiological parameters were analyzed for their potential in outcome prediction. Differences were rated significant at p<0.05.
Results
No complication in relation to the insertion of the catheters were observed. Total monitoring time was 9.5 days (6.7 to 14.3 days). 30 children underwent surgical hematoma evacuation (epidural, n=14; subdural, n=13, contusional hemorrhage, n=3). In 8 children, decompressive surgery was performed. Only in 3 of 8 children, normal ptiO2-values were measured, while 2 children had abnormally high btiO2-values (>35 mmHg) and 3 children episodes of cerebral hypoxia (<10 mmHg). Glutamate was pathologically elevated before decompressive surgery. Outcome after 1 year ranged 1-5 (mean 3.8).
Conclusions
In children with severe head injury, monitoring of CPP and metabolism enables to guide an individual therapeutical approach including decompressive surgery. This possibly improves outcome of these patients.
