Relationship of cerebral perfusion pressure and survival in pediatric brain-injured patients

C. Downard, F. Hulka, Richard Mullins, J. Piatt, R. Chesnut, P. Quint, N. Clay Mann, M. L. Ramenofsky, D. W. Vane, F. Hulka

    Research output: Contribution to journalArticle

    128 Citations (Scopus)

    Abstract

    Background: Adult brain injury studies recommend maintaining cerebral perfusion pressure (CPP) above 70 mm Hg. We evaluated CPP and outcome in brain-Injured children. Methods: We retrospectively reviewed the hospital courses of children at two Level I trauma centers who required insertion of intracranial pressure (ICP) monitors for management of traumatic brain injury. ICP, CPP, and mean arterial pressure were evaluated hourly, and means were calculated for the first 48 hours after injury. Results: of 188 brain-Injured children, 118 had ICP monitors placed within 24 hours of injury. They suffered severe brain injury, with average admitting Glasgow Coma Scale scores of 6 ± 3. Overall mortality rate was 28%. No patient with mean CPP less than 40 mm Hg survived. Among patients with mean CPP in deciles of 40 to49, 50 to 59, 60 to 69, or 70 mm Hg, no significant difference in Glasgow Outcome Scale distribution existed. Conclusion: Low mean CPP was lethal. In children with survivable brain injury (mean CPP > 40 mm Hg), CPP did not stratify patients for risk of adverse outcome.

    Original languageEnglish (US)
    Pages (from-to)654-659
    Number of pages6
    JournalJournal of Trauma - Injury, Infection and Critical Care
    Volume49
    Issue number4
    StatePublished - 2000

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    Cerebrovascular Circulation
    Pediatrics
    Survival
    Brain
    Intracranial Pressure
    Brain Injuries
    Glasgow Outcome Scale
    Glasgow Coma Scale
    Trauma Centers
    Wounds and Injuries
    Arterial Pressure

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Relationship of cerebral perfusion pressure and survival in pediatric brain-injured patients. / Downard, C.; Hulka, F.; Mullins, Richard; Piatt, J.; Chesnut, R.; Quint, P.; Clay Mann, N.; Ramenofsky, M. L.; Vane, D. W.; Hulka, F.

    In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 49, No. 4, 2000, p. 654-659.

    Research output: Contribution to journalArticle

    Downard, C, Hulka, F, Mullins, R, Piatt, J, Chesnut, R, Quint, P, Clay Mann, N, Ramenofsky, ML, Vane, DW & Hulka, F 2000, 'Relationship of cerebral perfusion pressure and survival in pediatric brain-injured patients', Journal of Trauma - Injury, Infection and Critical Care, vol. 49, no. 4, pp. 654-659.
    Downard, C. ; Hulka, F. ; Mullins, Richard ; Piatt, J. ; Chesnut, R. ; Quint, P. ; Clay Mann, N. ; Ramenofsky, M. L. ; Vane, D. W. ; Hulka, F. / Relationship of cerebral perfusion pressure and survival in pediatric brain-injured patients. In: Journal of Trauma - Injury, Infection and Critical Care. 2000 ; Vol. 49, No. 4. pp. 654-659.
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    T1 - Relationship of cerebral perfusion pressure and survival in pediatric brain-injured patients

    AU - Downard, C.

    AU - Hulka, F.

    AU - Mullins, Richard

    AU - Piatt, J.

    AU - Chesnut, R.

    AU - Quint, P.

    AU - Clay Mann, N.

    AU - Ramenofsky, M. L.

    AU - Vane, D. W.

    AU - Hulka, F.

    PY - 2000

    Y1 - 2000

    N2 - Background: Adult brain injury studies recommend maintaining cerebral perfusion pressure (CPP) above 70 mm Hg. We evaluated CPP and outcome in brain-Injured children. Methods: We retrospectively reviewed the hospital courses of children at two Level I trauma centers who required insertion of intracranial pressure (ICP) monitors for management of traumatic brain injury. ICP, CPP, and mean arterial pressure were evaluated hourly, and means were calculated for the first 48 hours after injury. Results: of 188 brain-Injured children, 118 had ICP monitors placed within 24 hours of injury. They suffered severe brain injury, with average admitting Glasgow Coma Scale scores of 6 ± 3. Overall mortality rate was 28%. No patient with mean CPP less than 40 mm Hg survived. Among patients with mean CPP in deciles of 40 to49, 50 to 59, 60 to 69, or 70 mm Hg, no significant difference in Glasgow Outcome Scale distribution existed. Conclusion: Low mean CPP was lethal. In children with survivable brain injury (mean CPP > 40 mm Hg), CPP did not stratify patients for risk of adverse outcome.

    AB - Background: Adult brain injury studies recommend maintaining cerebral perfusion pressure (CPP) above 70 mm Hg. We evaluated CPP and outcome in brain-Injured children. Methods: We retrospectively reviewed the hospital courses of children at two Level I trauma centers who required insertion of intracranial pressure (ICP) monitors for management of traumatic brain injury. ICP, CPP, and mean arterial pressure were evaluated hourly, and means were calculated for the first 48 hours after injury. Results: of 188 brain-Injured children, 118 had ICP monitors placed within 24 hours of injury. They suffered severe brain injury, with average admitting Glasgow Coma Scale scores of 6 ± 3. Overall mortality rate was 28%. No patient with mean CPP less than 40 mm Hg survived. Among patients with mean CPP in deciles of 40 to49, 50 to 59, 60 to 69, or 70 mm Hg, no significant difference in Glasgow Outcome Scale distribution existed. Conclusion: Low mean CPP was lethal. In children with survivable brain injury (mean CPP > 40 mm Hg), CPP did not stratify patients for risk of adverse outcome.

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