Article
Experiences of metabolic monitoring in pediatric head injury
Erfahrungen im metabolischen Monitoring beim Schädel-Hirn-Trauma im Kindes- und Jugendalter
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Published: | April 23, 2004 |
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Outline
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Objective
Experience in metabolic monitoring of paediatric head-injured patients is limited. Since several pathophysiological changes such as blood flow, compliance and resistance might be more pronounced compared to adults, metabolic monitoring might be more sensitive to those mechanisms. We present ten cases of head-injured paediatric patients with different injury patterns that were monitored by multimodal metabolic parameters.
Methods
In ten severely head-injured paediatric patients (mean age 14,5 years) ICP (Rehau), ptiO2 (Licox) and interstitial metabolic substrates (4 patients) using microdialysis (CMA 600) were continuously monitored. All data were collected together with clinical parameters into a data base and further analysed.
Results
In 4 patients monitoring was not pathological (ICP < 20mmHg, ptiO2 >10mmHg). In all other six patients, very different pathophysiological patterns were seen: ICA of a 14 year-old-boy had to be occluded by ballon after traumatic rupture. ptiO2 <10mmHg decreased afterwards in the affected vascular territory without ICP increase above 20mmHg; ventricular tapping leading to a slight lowering of ICP effectively increased ptiO2 >15mmHg. Effectiveness of decompression for treatment of traumatic brain swelling is represented by monitoring in a 9 year old boy, while in a 17-year-old male who herniated due to untractable brain swelling showed no “early signs” in monitoring prior to herniation. Another 14-year-old girl with intermittent short periods (<5min) of ICP between 40-50mmHg with simultaneously normal ptiO2 >20mmHg and without decompression showed an excellent outcome.
Conclusions
We observed very heterogeneous monitoring patterns in head injured paediatric patients. Even if metabolic monitoring does not replace measurement of ICP, it might allow a better estimation of underlying pathophysiological mechanisms such as brain swelling, intracranial bleeding or vessel occlusion. Furthermore, in individual cases such as vessel occlusion, bilateral monitoring should be considered.