Original Paper

Child's Nervous System

, Volume 25, Issue 10, pp 1335-1343

Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury

Part 2: Relationship with clinical, physiological, and treatment factors
  • Anthony A. FigajiAffiliated withDivisions of Neurosurgery, School of Child and Adolescent Health, University of Cape Town, Red Cross Children’s HospitalInstitute for Child Health, Red Cross War Memorial Children’s Hospital Email author 
  • , Eugene ZwaneAffiliated withInfectious Disease Epidemiology Unit (Biostatistics), School of Public Health and Family Medicine, University of Cape Town
  • , Crispin ThompsonAffiliated withDivisions of Neurosurgery, School of Child and Adolescent Health, University of Cape Town, Red Cross Children’s Hospital
  • , A. Graham FieggenAffiliated withDivisions of Neurosurgery, School of Child and Adolescent Health, University of Cape Town, Red Cross Children’s Hospital
  • , Andrew C. ArgentAffiliated withPediatric Critical Care, School of Child and Adolescent Health, University of Cape Town, Red Cross Childrens Hospital
  • , Peter D. Le RouxAffiliated withDepartment of Neurosurgery, Hospital of the University of Pennsylvania
  • , Jonathan C. PeterAffiliated withDivisions of Neurosurgery, School of Child and Adolescent Health, University of Cape Town, Red Cross Children’s Hospital

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Abstract

Introduction

Brain tissue oxygen tension (PbtO2) monitoring is used increasingly in adult severe traumatic brain injury (TBI) management. Several factors are known to influence PbtO2 in adults, but the variables that affect PbtO2 in pediatric TBI are not well described. This study examines the relationships between PbtO2 and (1) physiological markers of potential secondary insults commonly used in pediatric TBI, in particular intracranial pressure (ICP), cerebral perfusion pressure (CPP), and systemic hypoxia, and (2) other clinical factors and treatment received that may influence PbtO2.

Materials and methods

In this prospective observational study, 52 children (mean age, 6.5 ± 3.4 years; range, 9 months to 14 years old) with severe TBI and a median post-resuscitation Glasgow Coma Score (GCS) of 5 were managed with continuous PbtO2 monitoring. The relationships between PbtO2 parameters (\({\text{PbtO}}_{2_{{\text{low}}} } \), PbtO2 < 5, PbtO2 < 10, and \({\text{mPbtO}}_{2_{{\text{24}}} } \)) and clinical, physiological, and treatment factors were explored using time-linked data and Spearman’s correlation coefficients.

Results

No clinical, physiological, or treatment variable was significantly associated with all PbtO2 parameters, but individual associations were found with initial GCS (PbtO2 < 5, p = 0.0113), admission Pediatric Trauma Score (PbtO2 < 10, 0.0175), mICP > 20 (\({\text{mPbtO}}_{2_{{\text{24}}} } \), p = 0.0377), CPPlow (\({\text{PbtO}}_{2_{{\text{low}}} } \), p = 0.0065), CPP < 40 (\({\text{PbtO}}_{2_{{\text{low}}} } \), p = 0.0269; PbtO2 < 5, p = 0.0212), PaO2 < 60 (\({\text{mPbtO}}_{2_{{\text{24}}} } \), p = 0.0037), SaO2 < 90 (\({\text{PbtO}}_{2_{{\text{low}}} } \), p = 0.0438), and use of inotropes during ICU care (\({\text{PbtO}}_{2_{{\text{low}}} } \), p = 0.0276; PbtO2 < 10, p = 0.0277; p = \({\text{mPbtO}}_{2_{{\text{24}}} } \)).

Conclusion

Delivery of oxygen to the brain is important to limit secondary neuronal injury after severe TBI. Our data show that PbtO2 is poorly predicted by clinical and physiological factors commonly measured in the pediatric ICU. Multimodality monitoring may be needed to detect all secondary cerebral insults in pediatric TBI.

Keywords

Brain oxygen Children Traumatic brain injury Intracranial pressure Cerebral perfusion pressure Monitoring