EVENTS ASSOCIATED WITH THE OCCURRENCE OF INTRACRANIAL HYPERTENSION IN PEDIATRIC PATIENTS WITH SEVERE CRANIOENCEPHALIC TRAUMA AND MONITORING OF INTRACRANIAL PRESSURE

• Published in: Revista Paulista de Pediatria Vol. 38
• Main Authors: Guerra, Sérgio Diniz, Ferreira, Alexandre Rodrigues
• Format: Journal Article
• Language: English; Portuguese
• Published: Sociedade de Pediatria de São Paulo 01-01-2020
• Subjects: Adolescent; Child; Critical care; Head traumas; Intracranial hypertension; Intracranial pressure; Original
• ISSN: 0103-0582; 1984-0462
• DOI: 10.1590/1984-0462/2020/38/2019123

ABSTRACT Objective: To determine the events associated with the occurrence of intracranial hypertension (ICH) in pediatric patients with severe cranioencephalic trauma. Methods: This was a prospective cohort study of patients 18 years old and younger with cranioencephalic trauma, scores below nine on the Glasgow Coma Scale, and intracranial pressure monitoring. They were admitted between September, 2005 and March, 2014 into a Pediatric Intensive Care Unit. ICH was defined as an episode of intracranial pressure above 20 mmHg for more than five minutes that needed treatment. Results: A total of 198 children and adolescents were included in the study, of which 70.2% were males and there was a median age of nine years old. ICH occurred in 135 (68.2%) patients and maximum intracranial pressure was 36.3 mmHg, with a median of 34 mmHg. A total of 133 (97.8%) patients with ICH received sedation and analgesia for treatment of the condition, 108 (79.4%) received neuromuscular blockers, 7 (5.2%) had cerebrospinal fluid drainage, 105 (77.2%) received mannitol, 96 (70.6%) received hyperventilation, 64 (47.1%) received 3% saline solution, 20 (14.7%) received barbiturates, and 43 (31.9%) underwent a decompressive craniectomy. The events associated with the occurrence of ICH were tomographic findings at the time of admission of diffuse or hemispheric swelling (edema plus engorgement). The odds ratio for ICH in patients with Marshall III (diffuse swelling) tomography was 14 (95%CI 2.8–113; p<0.003), and for those with Marshall IV (hemispherical swelling) was 24.9 (95%CI 2.4–676, p<0.018). Mortality was 22.2%. Conclusions: Pediatric patients with severe cranioencephalic trauma and tomographic alterations of Marshall III and IV presented a high chance of developing ICH.
RESUMO Objetivo: Determinar eventos associados à ocorrência de hipertensão intracraniana (HIC) em pacientes pediátricos com traumatismo cranioencefálico grave. Métodos: Trata-se de coorte prospectiva de pacientes de até 18 anos, com traumatismo cranioencefálico, pontuação abaixo de nove na Escala de Coma de Glasgow e monitoração da pressão intracraniana, admitidos entre setembro de 2005 e março de 2014 em unidade de terapia intensiva pediátrica. A HIC foi definida como episódio de pressão intracraniana acima de 20 mmHg por mais de cinco minutos e com necessidade de tratamento. Resultados: Incluídas 198 crianças e adolescentes, 70,2% masculinos, mediana de idade de nove anos. A HIC ocorreu em 135 (68,2%) pacientes; valor máximo de pressão intracraniana de 36,3; mediana 34 mmHg. Receberam sedação e analgesia para tratamento da HIC 133 (97,8%) pacientes, 108 (79,4%) receberam bloqueadores neuromusculares, 7 (5,2%) drenagem de líquor, 105 (77,2%) manitol, 96 (70,6%) hiperventilação, 64 (47,1%) solução salina a 3%, 20 (14,7%) barbitúricos e 43 (31,9%) foram submetidos à craniectomia descompressiva. Os eventos associados à ocorrência de HIC foram os achados tomográficos à admissão de swelling (edema mais ingurgitamento) difuso ou hemisférico. A razão de chance para que pacientes com classificação tomográfica Marshall III (swelling difuso) apresentassem HIC foi 14 (IC95% 2,8–113; p<0,003) e para aqueles com Marshall IV (hemisférico) foi 24,9 (IC95% 2,4–676; p<0,018). A mortalidade foi de 22,2%. Conclusões: Pacientes pediátricos com traumatismo cranioencefálico grave e alterações tomográficas tipo Marshall III e IV apresentaram grande chance de desenvolver HIC.