Document Detail


Intracranial pressure-monitoring systems in children with traumatic brain injury: combining therapeutic and diagnostic tools.
MedLine Citation:
PMID:  20625341     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare the correlation of intracranial pressure (ICP) measurement and time to detection of ICP crises (defined as ICP ≥ 20 mm Hg for ≥ 5 mins) between an intraparenchymal (IP) monitor and external ventricular drain (EVD) in children for whom continuous cerebrospinal fluid diversion was used as a therapy for severe traumatic brain injury.
SETTING: Academic, pediatric intensive care unit.
DESIGN: Retrospective review of a prospectively collected pediatric neurotrauma database.
PATIENTS: Children with severe traumatic brain injury (Glasgow Coma Scale score of ≤ 8) who underwent ICP monitoring with both IP and EVD techniques were studied. In cohort 1 (n = 58), hourly ICP measurements were extracted from the medical record; in cohort 2 (n = 4), ICP measurements were collected every minute by an automated data-collection system.
MEASUREMENTS AND MAIN RESULTS: The mean absolute difference in ICP (|N5ICP|N5) and intraclass correlation coefficients were calculated. Timing to detection of ICP crises was analyzed. Data were expressed as mean ± sem. For cohort 1, 7,387 hrs of data were analyzed; 399 hrs (23,940 mins) were analyzed for cohort 2. In cohort 1, the |N5ICP|N5 was 3.10 ± 0.04 mm Hg (intraclass correlation coefficients = 0.98, p < .001). The |N5ICP|N5 in cohort 2 was 3.30 ± 0.05 mm Hg (intraclass correlation coefficients = 0.98, p < .001). In cohort 2, a total of 75 ICP crises were observed. Fifty-five (73%) were detected first by the IP monitor, of which 35 were not identified by the EVD monitor. Time between IP and EVD detection of a crisis was 12.60 ± 2.34 mins.
CONCLUSION: EVD and IP measurements of ICP were highly correlated, although intermittent EVD ICP measurements may fail to identify ICP events when continuously draining cerebrospinal fluid. In institutions that use continuous cerebrospinal fluid diversion as a therapy, a two-monitor system may be valuable for accomplishing monitoring and therapeutic goals.
Authors:
Jennifer Exo; Patrick M Kochanek; P David Adelson; Stephanie Greene; Robert S B Clark; Hülya Bayir; Stephen R Wisniewski; Michael J Bell
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  12     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-08     Completed Date:  2012-05-14     Revised Date:  2013-06-06    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  560-5     Citation Subset:  IM    
Affiliation:
Departments of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. exojl@upmc.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Brain Injuries / diagnosis,  physiopathology*,  therapy
Child
Databases, Factual
Female
Humans
Intensive Care Units, Pediatric
Intracranial Pressure / physiology*
Male
Monitoring, Physiologic / methods*
Retrospective Studies
Trauma Severity Indices
Grant Support
ID/Acronym/Agency:
5T32HD040686/HD/NICHD NIH HHS; HD08003/HD/NICHD NIH HHS; NS052478/NS/NINDS NIH HHS; NS30318/NS/NINDS NIH HHS; T32 HD040686/HD/NICHD NIH HHS
Comments/Corrections
Comment In:
Pediatr Crit Care Med. 2011 Sep;12(5):600-1   [PMID:  21897164 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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