颅内高压负担与MRI脑损伤模式:2014-2017年“急性儿科TBI的方法和决策”研究的二次分析

IF 4.5 2区 医学 Q1 CRITICAL CARE MEDICINE
Anna M Janas, Aimee T Broman, Tellen D Bennett, Susan Rebsamen, Aaron S Field, Bedda L Rosario, Michael J Bell, Andrew L Alexander, Peter A Ferrazzano
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引用次数: 0

摘要

目的:颅内压升高(ICP)是严重创伤性脑损伤(TBI)的并发症,具有继发性脑损伤的风险。本研究调查了严重TBI患儿颅内压负荷与MRI脑损伤模式之间的关系。设计、环境和患者:对急性儿童TBI (ADAPT)研究的方法和决策的二次分析,该研究包括在损伤后30天内接受临床MRI检查的严重TBI儿童(格拉斯哥昏迷评分< 9)。我们排除了ICP监测少于24小时的患者,ICP数据缺失超过40%的监测时间,或接受了颅骨切除术的患者。干预措施:没有。测量方法和主要结果:ICP负担定义为每小时ICP大于20 mm Hg曲线下的梯形面积,ICP标准化为总监测时间,并将患者分为四个水平的ICP负担。MRI检查弥漫性轴索损伤(DAI)微出血数、脑出血(ICH)体积、挫伤体积、缺血区数。采用Fisher精确检验或卡方检验检验颅内压负荷与MRI损伤量的相关性。220例患者中,MRI显示DAI 156例(71%),ICH 31例(14%),挫伤161例(73%),缺血70例(32%)。大多数患者(180,82%)经历了大于20 mm Hg的ICP发作。挫伤体积(p = 0.02)和缺血区域数量(p = 0.007)与ICP负担相关,但我们未能确定DAI或ICH的这种关联。严重(但不是轻度或中度)颅内压负荷与缺血存在相关(优势比4.64 [95% CI, 1.30-19.5]; p = 0.02)。结论:ICP升高在ADAPT队列中普遍存在。缺血和挫伤与颅内压负荷有关。需要进一步的研究来确定ICP升高和缺血之间的时间关系。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Burden of Intracranial Hypertension and Patterns of Brain Injury on MRI: Secondary Analysis of the 2014-2017 "Approaches and Decisions for Acute Pediatric TBI" Study.

Objectives: Elevated intracranial pressure (ICP) is a complication of severe traumatic brain injury (TBI) that carries a risk of secondary brain injury. This study investigated the association between ICP burden and brain injury patterns on MRI in children with severe TBI.

Design, setting, and patients: Secondary analysis of the Approaches and Decisions in Acute Pediatric TBI (ADAPT) study, which included children with severe TBI (Glasgow Coma Scale score < 9) who received a clinical MRI within 30 days of injury. We excluded patients who had ICP monitoring less than 24 hours, were missing ICP data for greater than 40% of monitoring time, or who underwent craniectomy.

Interventions: None.

Measurements and main results: ICP burden was defined as the trapezoidal area under the curve of hourly ICP greater than 20 mm Hg. ICP was standardized to total monitoring time, and patients were categorized to four levels of ICP burden. MRI was evaluated for number of diffuse axonal injury (DAI) microhemorrhages, intracerebral hemorrhage (ICH) volume, contusion volume, and number of regions with ischemia. Fisher exact or chi-square tests were used to test the independence between ICP burden and MRI injury amount. Of the 220 patients, 156 (71%) had DAI, 31 (14%) had ICH, 161 (73%) had contusions, and 70 (32%) had ischemia on MRI. Most patients (180, 82%) experienced episodes of ICP greater than 20 mm Hg. Contusion volume (p = 0.02) and number of regions with ischemia (p = 0.007) were associated with ICP burden, but we failed to identify such an association for DAI or ICH. Severe (but not mild or moderate) ICP burden was associated with presence of ischemia (odds ratio, 4.64 [95% CI, 1.30-19.5]; p = 0.02).

Conclusions: Elevated ICP was prevalent in the ADAPT cohort. Ischemia and contusion were associated with the burden of ICP. Further research is needed to determine temporal relationships between elevated ICP and ischemia.

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来源期刊
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine 医学-危重病医学
CiteScore
7.40
自引率
14.60%
发文量
991
审稿时长
3-8 weeks
期刊介绍: Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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