TY - JOUR
T1 - Visualization of the Intracranial Pressure and Time Burden in Childhood Brain Trauma
T2 - What We Have Learned One Decade on With KidsBrainIT
AU - Kempen, Bavo
AU - Depreitere, Bart
AU - Piper, Ian
AU - Sahuquillo, Juan
AU - Mircea Iencean, Stefan
AU - Krishnan Kanthimathinathan, Hari
AU - Zipfel, Julian
AU - Barzdina, Arta
AU - Pezzato, Stefano
AU - Jones, Patricia A
AU - Lo, Tsz-Yan Milly M
N1 - Publisher Copyright:
© Mary Ann Liebert, Inc.
PY - 2024/7/1
Y1 - 2024/7/1
N2 - To validate the intracranial pressure (ICP) dose-response visualization plot for the first time in a novel prospectively collected pediatric traumatic brain injury (pTBI) data set from the multi-center multi-national KidsBrainIT consortium. Prospectively collected minute-by-minute ICP and mean arterial blood pressure time series of 104 pTBI patients were categorized in ICP intensity-duration episodes. These episodes were correlated with the 6-month Glasgow Outcome Score (GOS) and displayed in a color-coded ICP dose-response plot. The influence of cerebrovascular reactivity and cerebral perfusion pressure (CPP) were investigated. The generated ICP dose-response plot on the novel data set was similar to the previously published pediatric plot. This study confirmed that higher ICP episodes were tolerated for a shorter duration of time, with an approximately exponential decay curve delineating the positive and negative association zones. ICP above 20 mmHg for any duration in time was associated with poor outcome in our patients. Cerebrovascular reactivity state did not influence their respective transition curves above 10 mmHg ICP. CPP below 50 mmHg was not tolerated, regardless of ICP and duration, and was associated with worse outcome. The ICP dose-response plot was reproduced in a novel and independent pTBI data set. ICP above 20 mmHg and CPP below 50 mmHg for any duration in time were associated with worse outcome. This highlighted a pressing need to reduce pediatric ICP therapeutic thresholds used at the bedside.
AB - To validate the intracranial pressure (ICP) dose-response visualization plot for the first time in a novel prospectively collected pediatric traumatic brain injury (pTBI) data set from the multi-center multi-national KidsBrainIT consortium. Prospectively collected minute-by-minute ICP and mean arterial blood pressure time series of 104 pTBI patients were categorized in ICP intensity-duration episodes. These episodes were correlated with the 6-month Glasgow Outcome Score (GOS) and displayed in a color-coded ICP dose-response plot. The influence of cerebrovascular reactivity and cerebral perfusion pressure (CPP) were investigated. The generated ICP dose-response plot on the novel data set was similar to the previously published pediatric plot. This study confirmed that higher ICP episodes were tolerated for a shorter duration of time, with an approximately exponential decay curve delineating the positive and negative association zones. ICP above 20 mmHg for any duration in time was associated with poor outcome in our patients. Cerebrovascular reactivity state did not influence their respective transition curves above 10 mmHg ICP. CPP below 50 mmHg was not tolerated, regardless of ICP and duration, and was associated with worse outcome. The ICP dose-response plot was reproduced in a novel and independent pTBI data set. ICP above 20 mmHg and CPP below 50 mmHg for any duration in time were associated with worse outcome. This highlighted a pressing need to reduce pediatric ICP therapeutic thresholds used at the bedside.
UR - http://www.scopus.com/inward/record.url?scp=85189882498&partnerID=8YFLogxK
U2 - 10.1089/neu.2023.0254
DO - 10.1089/neu.2023.0254
M3 - Article
C2 - 38425208
SN - 0897-7151
VL - 41
SP - e1651-e1659
JO - Journal of Neurotrauma
JF - Journal of Neurotrauma
IS - 13-14
ER -