Intervention thresholds of intracranial pressure and cerebral perfusion pressure in children with severe traumatic brain injury

Objective To analyze the clinical characteristics of changes in intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and determine their intervention thresholds in children with severe traumatic brain injury (STBI). Methods This prospective observational study was conducted among the children with STBI admitted in the Children's Hospital of Chongqing Medical University between June, 2014 and June 2018. ICP and CPP of the children were dynamically monitored at every hour after the operation. The theoretical thresholds of ICP and CPP were adopted from literature, and the pressure-time indexes (PTIs) for these thresholds were calculated and their predictive ability was assessed using the receiver operating characteristic (ROC) curve. For children in different age groups (< 2 years, 2-7 years and >7 years), the area under the ROC curve (AUC) was calculated according to the PTIs for each theoretical threshold and Glasgow Outcome Scale score at 6 months after the trauma. The theoretical thresholds corresponding to the maximum AUC was determined to be the optimal thresholds. Results A total of 115 children with STBI were included in this study. For children aged < 2 years (25 cases), 2-7 years (52 cases) and >7 years (38 cases), the age-specific thresholds of ICP was 14.4, 20.0 and 21.6 mmHg, and those of CPP was 45.0, 55.0 and 55.0 mmHg respectively. Conclusion The intervention thresholds of ICP and CPP differ among the STBI chidren at different ages. In children with STBI aged < 2 years, 2-7 years and >7 years, we recommend postoperative ICP of 14.4, 20.0 and 21.6 mmHg, and CCP of 45.0, 55.0 and 55.0 mmHg respectively, as the thresholds for initiating interventions.