Brain tissue oxygen monitoring in pediatric patients with severe traumatic brain injury

Object. Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring are fundamental to the management of severe traumatic brain injury (TBI). In adults, brain tissue oxygen monitoring (specifically PO₂) and treatment have been shown to be safe additions to conventional neurocritical care and are associated with improved outcome. Brain tissue oxygen monitoring, however, has not been described in pediatric patients with TBI. In this report, the authors present preliminary experience with the use of ICP and PO ₂ monitoring in this population. Methods. Pediatric patients (age < 18 years) with severe TBI (Glasgow Coma Scale score < 8) admitted to a Level 1 trauma center who underwent ICP and PO₂ monitoring were evaluated. Therapy was directed at maintaining ICP below 20 mm Hg and age-appropriate CPP (≥ 40 mm Hg). Data obtained in six patients (two girls and four boys ranging in age from 6-16 years) were analyzed. Brain tissue oxygen levels were significantly higher (p < 0.01) at an ICP of less than 20 mm Hg (PO₂ 29.29 ± 7.17 mm Hg) than at an ICP of greater than or equal to 20 mm Hg (PO₂ 22.83 ± 13.85 mm Hg). Significant differences (p < 0.01) were also measured when CPP was less than 40 mm Hg (PO₂ 2.53 ± 7.98 mm Hg) and greater than or equal to 40 mm Hg (PO₂ 28.97 ± 7.85 mm Hg). Conclusions. Brain tissue oxygen monitoring may be a safe and useful addition to ICP monitoring in the treatment of pediatric patients with severe TBI.