Variations of the blood gas levels and thermodilutional parameters during ICP monitoring after severe head trauma in children

Riccardo Lubrano, Marco Elli, Francesca Stoppa, Mario Di Traglia, Matteo Di Nardo, Daniela Perrotta, Piero David, Sara Paoli, Corrado Cecchetti

Research output: Contribution to journalArticle

Abstract

Purpose: The purpose of this study was to define, in children following head trauma and GSC ≤ 8, at which level of intracranial pressure (ICP), the thermodilutional, and gas analytic parameters implicated in secondary cerebral insults shows initial changes. Methods: We enrolled in the study 56 patients: 30 males and 26 females, mean age 71 ± 52 months. In all children, volumetric hemodynamic and blood gas parameters were monitored following initial resuscitation and every 4 h thereafter or whenever a hemodynamic deterioration was suspected. During the cumulative hospital stay, a total of 1050 sets of measurements were done. All parameters were stratified in seven groups according to ICP (group A1 = 0–5 mmHg, group A2 = 6–10 mmHg, group A3 = 11–15 mmHg, group A4 16–20 mmHg, group A5 21–25 mmHg, group A6 26–30 mmHg, group A7 >31 mmHg). Results: Mean values of jugular oxygen saturation (SJO2), jugular oxygen partial pressure (PJO2), extravascular lung water (EVLWi), pulmonary vascular permeability (PVPi), fluid overload (FO), and cerebral extraction of oxygen (CEO2) vary significantly from A3 (11–15 mmHg) to A4 (16–20 mmHg). They relate to ICP in a four-parameter sigmoidal function (4PS function with: r2 = 0.90), inflection point of 15 mmHg of ICP, and a maximum curvature point on the left horizontal asymptote at 13 mmHg of ICP. Conclusions: Mean values of SJO2, PJO2, EVLWi, PVPi, FO, and CEO2 become pathologic at 15 mmHg of ICP; however, the curve turns steeper at 13 mmHg, possibly a warning level in children for the development of post head trauma secondary insult.

Original languageEnglish
Pages (from-to)1273-1281
Number of pages9
JournalChild's Nervous System
Volume31
Issue number8
DOIs
Publication statusPublished - Aug 27 2015

Fingerprint

Intracranial Pressure
Craniocerebral Trauma
Gases
Capillary Permeability
Oxygen
Neck
Hemodynamics
Pneumocephalus
Extravascular Lung Water
Lung
Partial Pressure
Child Development
varespladib methyl
Resuscitation
Length of Stay

Keywords

  • Brain oxygenation
  • Children
  • Extravascular lung water
  • Head injury
  • Intracranial pressure

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Variations of the blood gas levels and thermodilutional parameters during ICP monitoring after severe head trauma in children. / Lubrano, Riccardo; Elli, Marco; Stoppa, Francesca; Di Traglia, Mario; Di Nardo, Matteo; Perrotta, Daniela; David, Piero; Paoli, Sara; Cecchetti, Corrado.

In: Child's Nervous System, Vol. 31, No. 8, 27.08.2015, p. 1273-1281.

Research output: Contribution to journalArticle

Lubrano, Riccardo ; Elli, Marco ; Stoppa, Francesca ; Di Traglia, Mario ; Di Nardo, Matteo ; Perrotta, Daniela ; David, Piero ; Paoli, Sara ; Cecchetti, Corrado. / Variations of the blood gas levels and thermodilutional parameters during ICP monitoring after severe head trauma in children. In: Child's Nervous System. 2015 ; Vol. 31, No. 8. pp. 1273-1281.
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abstract = "Purpose: The purpose of this study was to define, in children following head trauma and GSC ≤ 8, at which level of intracranial pressure (ICP), the thermodilutional, and gas analytic parameters implicated in secondary cerebral insults shows initial changes. Methods: We enrolled in the study 56 patients: 30 males and 26 females, mean age 71 ± 52 months. In all children, volumetric hemodynamic and blood gas parameters were monitored following initial resuscitation and every 4 h thereafter or whenever a hemodynamic deterioration was suspected. During the cumulative hospital stay, a total of 1050 sets of measurements were done. All parameters were stratified in seven groups according to ICP (group A1 = 0–5 mmHg, group A2 = 6–10 mmHg, group A3 = 11–15 mmHg, group A4 16–20 mmHg, group A5 21–25 mmHg, group A6 26–30 mmHg, group A7 >31 mmHg). Results: Mean values of jugular oxygen saturation (SJO2), jugular oxygen partial pressure (PJO2), extravascular lung water (EVLWi), pulmonary vascular permeability (PVPi), fluid overload (FO), and cerebral extraction of oxygen (CEO2) vary significantly from A3 (11–15 mmHg) to A4 (16–20 mmHg). They relate to ICP in a four-parameter sigmoidal function (4PS function with: r2 = 0.90), inflection point of 15 mmHg of ICP, and a maximum curvature point on the left horizontal asymptote at 13 mmHg of ICP. Conclusions: Mean values of SJO2, PJO2, EVLWi, PVPi, FO, and CEO2 become pathologic at 15 mmHg of ICP; however, the curve turns steeper at 13 mmHg, possibly a warning level in children for the development of post head trauma secondary insult.",
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T1 - Variations of the blood gas levels and thermodilutional parameters during ICP monitoring after severe head trauma in children

AU - Lubrano, Riccardo

AU - Elli, Marco

AU - Stoppa, Francesca

AU - Di Traglia, Mario

AU - Di Nardo, Matteo

AU - Perrotta, Daniela

AU - David, Piero

AU - Paoli, Sara

AU - Cecchetti, Corrado

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AB - Purpose: The purpose of this study was to define, in children following head trauma and GSC ≤ 8, at which level of intracranial pressure (ICP), the thermodilutional, and gas analytic parameters implicated in secondary cerebral insults shows initial changes. Methods: We enrolled in the study 56 patients: 30 males and 26 females, mean age 71 ± 52 months. In all children, volumetric hemodynamic and blood gas parameters were monitored following initial resuscitation and every 4 h thereafter or whenever a hemodynamic deterioration was suspected. During the cumulative hospital stay, a total of 1050 sets of measurements were done. All parameters were stratified in seven groups according to ICP (group A1 = 0–5 mmHg, group A2 = 6–10 mmHg, group A3 = 11–15 mmHg, group A4 16–20 mmHg, group A5 21–25 mmHg, group A6 26–30 mmHg, group A7 >31 mmHg). Results: Mean values of jugular oxygen saturation (SJO2), jugular oxygen partial pressure (PJO2), extravascular lung water (EVLWi), pulmonary vascular permeability (PVPi), fluid overload (FO), and cerebral extraction of oxygen (CEO2) vary significantly from A3 (11–15 mmHg) to A4 (16–20 mmHg). They relate to ICP in a four-parameter sigmoidal function (4PS function with: r2 = 0.90), inflection point of 15 mmHg of ICP, and a maximum curvature point on the left horizontal asymptote at 13 mmHg of ICP. Conclusions: Mean values of SJO2, PJO2, EVLWi, PVPi, FO, and CEO2 become pathologic at 15 mmHg of ICP; however, the curve turns steeper at 13 mmHg, possibly a warning level in children for the development of post head trauma secondary insult.

KW - Brain oxygenation

KW - Children

KW - Extravascular lung water

KW - Head injury

KW - Intracranial pressure

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