Your browser doesn't support javascript.
loading
Implementation of Multimodality Neurologic Monitoring Reporting in Pediatric Traumatic Brain Injury Management.
Appavu, Brian; Burrows, Brian T; Nickoles, Todd; Boerwinkle, Varina; Willyerd, Anthony; Gunnala, Vishal; Mangum, Tara; Marku, Iris; Adelson, P D.
Afiliação
  • Appavu B; Department of Neurosciences, Barrow Neurological Institute At Phoenix Children's Hospital, 1919 E. Thomas Road, Ambulatory Building B, 3rd floor, Phoenix, AZ, 85016, USA. bappavu@phoenixchildrens.com.
  • Burrows BT; Department of Child Health, University Arizona College of Medicine -Phoenix, 550 E. Van Buren Street, Phoenix, AZ, 85004, USA. bappavu@phoenixchildrens.com.
  • Nickoles T; Department of Neurosciences, Barrow Neurological Institute At Phoenix Children's Hospital, 1919 E. Thomas Road, Ambulatory Building B, 3rd floor, Phoenix, AZ, 85016, USA.
  • Boerwinkle V; Department of Surgery, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.
  • Willyerd A; Department of Neurosciences, Barrow Neurological Institute At Phoenix Children's Hospital, 1919 E. Thomas Road, Ambulatory Building B, 3rd floor, Phoenix, AZ, 85016, USA.
  • Gunnala V; Department of Child Health, University Arizona College of Medicine -Phoenix, 550 E. Van Buren Street, Phoenix, AZ, 85004, USA.
  • Mangum T; Department of Critical Care Medicine, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.
  • Marku I; Department of Critical Care Medicine, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.
  • Adelson PD; Department of Neurosciences, Barrow Neurological Institute At Phoenix Children's Hospital, 1919 E. Thomas Road, Ambulatory Building B, 3rd floor, Phoenix, AZ, 85016, USA.
Neurocrit Care ; 35(1): 3-15, 2021 08.
Article em En | MEDLINE | ID: mdl-33791948
BACKGROUND/OBJECTIVE: Multimodality neurologic monitoring (MMM) is an emerging technique for management of traumatic brain injury (TBI). An increasing array of MMM-derived biomarkers now exist that are associated with injury severity and functional outcomes after TBI. A standardized MMM reporting process has not been well described, and a paucity of evidence exists relating MMM reporting in TBI management with functional outcomes or adverse events. METHODS: Prospective implementation of standardized MMM reporting at a single pediatric intensive care unit (PICU) is described that included monitoring of intracranial pressure (ICP), cerebral oxygenation and electroencephalography (EEG). The incidence of clinical decisions made using MMM reporting is described, including timing of neuroimaging, ICP monitoring discontinuation, use of paralytic, hyperosmolar and pentobarbital therapies, neurosurgical interventions, ventilator and CPP adjustments and neurologic prognostication discussions. Retrospective analysis was performed on the association of MMM reporting with initial Glasgow Coma Scale (GCS) and Pediatric Risk of Mortality III (PRISM III) scores, duration of total hospitalization and PICU hospitalization, duration of mechanical ventilation and invasive ICP monitoring, inpatient complications, time with ICP > 20 mmHg, time with cerebral perfusion pressure (CPP) < 40 mmHg and 12-month Glasgow Outcome Scale-Extended Pediatrics (GOSE-Peds) scores. Association of outcomes with MMM reporting was investigated using the Wilcoxon rank-sum test or Fisher's exact test, as appropriate. RESULTS: Eighty-five children with TBI underwent MMM over 6 years, among which 18 underwent daily MMM reporting over a 21-month period. Clinical decision-making influenced by MMM reporting included timing of neuroimaging (100.0%), ICP monitoring discontinuation (100.0%), timing of extubation trials of surviving patients (100.0%), body repositioning (11.1%), paralytic therapy (16.7%), hyperosmolar therapy (22.2%), pentobarbital therapy (33.3%), provocative cerebral autoregulation testing (16.7%), adjustments in CPP thresholds (16.7%), adjustments in PaCO2 thresholds (11.1%), neurosurgical interventions (16.7%) and neurologic prognostication discussions (11.1%). The implementation of MMM reporting was associated with a reduction in ICP monitoring duration (p = 0.0017) and mechanical ventilator duration (p = 0.0018). No significant differences were observed in initial GCS or PRISM III scores, total hospitalization length, PICU hospitalization length, total complications, time with ICP > 20 mmHg, time with CPP < 40 mmHg, use of tier 2 therapy, or 12-month GOS-E Peds scores. CONCLUSION: Implementation of MMM reporting in pediatric TBI management is feasible and can be impactful in tailoring clinical decisions. Prospective work is needed to understand the impact of MMM and MMM reporting systems on functional outcomes and clinical care efficacy.
Assuntos
Palavras-chave

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pediatria / Lesões Encefálicas Traumáticas Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Child / Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pediatria / Lesões Encefálicas Traumáticas Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Child / Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article