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Child's Nervous System

, Volume 30, Issue 8, pp 1393–1398 | Cite as

Intraoperative blood loss during decompressive craniectomy for intractable intracranial hypertension after severe traumatic brain injury in children

  • François-Pierrick DesgrangesEmail author
  • Etienne Javouhey
  • Carmine Mottolese
  • Anne Migeon
  • Alexandru Szathmari
  • Florent Baudin
  • Mathilde de Queiroz
  • Bérengère Cogniat
  • Dominique Chassard
Original Paper

Abstract

Purpose

There are no data available on the risk of intraoperative bleeding during decompressive craniectomy (DC) after traumatic brain injury (TBI) in children. The objectives of this study were to assess the risk of intraoperative bleeding during DC for intractable intracranial hypertension after TBI, to identify potential factors associated with the risk of bleeding during DC, and to assess the impact of DC on systemic and cerebral hemodynamics and on coagulation.

Methods

Twelve children were identified as having undergone DC after TBI from April 2009 to June 2013 in our center. Subjects were allocated into two groups according to the percentage of blood loss (IBL) during the intraoperative period (<or ≥50 % of the estimated blood volume (EBV)).

Results

The median IBL during DC was 49 [17–349] % of the EBV. Children with an IBL ≥ 50 % of EBV had higher preoperative intracranial pressure (ICP) (p = 0.03) and international normalized ratio (INR) (p = 0.02) than those with an IBL < 50 % of EBV. DC induced significant decreases in ICP (p = 0.0005), mean arterial pressure (p = 0.01), and a significant increase in norepinephrine flow rate (p = 0.04) between the immediate pre- and postoperative periods.

Conclusions

DC allows a significant decrease in ICP after severe pediatric TBI but is a surgical procedure at a high risk of bleeding. High ICP and INR during the immediate preoperative period are the main factors associated with increased IBL during DC. Further studies are needed to confirm our results and to assess the impact of the amount of IBL on the postoperative survival and functional outcome.

Keywords

Decompressive craniectomy Traumatic brain injury Child Blood loss Coagulopathy Hemodynamics 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • François-Pierrick Desgranges
    • 1
    • 4
    Email author
  • Etienne Javouhey
    • 2
  • Carmine Mottolese
    • 3
  • Anne Migeon
    • 1
  • Alexandru Szathmari
    • 3
  • Florent Baudin
    • 2
  • Mathilde de Queiroz
    • 1
  • Bérengère Cogniat
    • 1
  • Dominique Chassard
    • 1
  1. 1.Department of Pediatric Anesthesia, Hôpital Femme Mère Enfant (Hospices Civils de Lyon)Université Claude Bernard Lyon 1LyonFrance
  2. 2.Department of Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant (Hospices Civils de Lyon)Université Claude Bernard Lyon 1LyonFrance
  3. 3.Department of Pediatric Neurosurgery, Hôpital Neurologique Pierre Weirtheimer et Hôpital Femme Mère Enfant (Hospices Civils de Lyon)Université Claude Bernard Lyon 1LyonFrance
  4. 4.Département d’Anesthésie-Réanimation, Hôpital Femme Mère EnfantHospices Civils de LyonBronFrance

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