Purpose
Current Brain Trauma Foundation guidelines recommend avoiding hypoxemia after severe pediatric Traumatic brain injury (TBI). Yet, recent studies on optimum admission oxygenation and ventilation parameters associated with discharge survival in pediatric TBI are lacking.
Materials and Methods
After IRB approval, a retrospective study involving pediatric patients ages ≤ 14 years with severe TBI (head Abbreviated Injury Scale (AIS) score ≥ 3, Glasgow Coma Scale (GCS) score ≤ 8 on admission) admitted to Harborview Medical Center (Level 1 pediatric trauma center), Seattle, WA, during 2003 to 2007 was performed. Admission demographics, clinical data and laboratory characteristics were abstracted. Hypoxemia was defined as PaO2 < 60 mmHg, hypocarbia was defined as PaCO2 ≤ 35 mmHg and hypercarbia was defined as PaCO2 ≥ 46 mmHg.
Results
194 patients met inclusion criteria of which 162 (83.5%) patients survived. Admission hypoxemia occurred in 9 (5.6%) patients who survived and 8 (25%) patients who died (p < 0.001). Children with admission PaCO2 between 36–45 mmHg had greater discharge survival compared to those with both admission hypocarbia (PaCO2 ≤ 35 mmHg) and hypercarbia (PaCO2 ≥ 46 mmHg). Admission PaO2 301–500 mmHg (AOR 8.02 [95% CI 1.73 – 37.10]; p = 0.008) and admission PaCO2 36–45 mmHg (AOR 5.47 [95% CI 1.30 – 23.07]; p = 0.02) were independently associated with discharge survival.
Conclusion
Discharge survival after severe pediatric TBI was associated with admission PaO2 301–500 mmHg and PaCO2 36–45 mmHg. Admission hypocarbia and hypercarbia were each associated with increased discharge mortality.
When used to facilitate intracranial aneurysm clip ligation, adenosine-induced flow arrest was associated with no more than a 15.7% increase or a 12.7% decrease in the incidence of a poor neurologic outcome at either 48 hours or at the time of hospital discharge. In addition, adenosine use was not associated with cardiac morbidity in the perioperative period (i.e., persistent arrhythmia or biomarkers of cardiac ischemia).
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