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| The clnical evaluation of carbon dioxide reactivity of cerebral blood vessels in children with moderate and severe traumatic brain injury |
| Cao Hai-wei, Wang Bao-hui, Li Wei, Zhou Jing, Mu Yu |
| Department of Ultrasound, Kaifeng Children's Hospital, Kaifeng 475000, China |
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Abstract Objective: To evaluate the changes of cerebrovascular carbon dioxide reactivity (CO2R) in children with traumatic brain injury (TBI) and the influence of CO2R damage on the prognosis of children.Methods: 128 children with TBI who were hospitalized in the department of neurosurgery intensive care unit (ICU) were selected. The relative CO2R values of the children were measured at admission to 48 h, and measured every 24 h.The pediatric Glasgow Outcome Scale (GOS-E Peds) was used to evaluatethe short-term outcome of the children. A ROC curve was used to determine CO2R cut-off values for favorable or unfavorable prognosis.The related factors that affect CO2R damage in children were analyzed. The children were grouped according to these factors (age, gender, and GOS-E Peds score). The CO2R values of children in different groups were compared, and Logistic regression model was used to evaluate predictors of prognosis. Results: There were 55 (43%) children with abnormal CO2R in admission to 48 h. The optimal cut-off value was 20.58% (AUC=0.816, P=0.025, the sensitivity was 0.75, specificity was 0.73, Youden index was 0.48).By the 4 th day after the recovery, the CO2R of most of the CO2R damaged children［47(85.5%)］had returned to normal.Compared with CO2R normal children, the age of CO2R damaged children was significantly lower ［(1.32±0.38) years old, vs. (8.97±1.71) years old, t=37.029, P<0.001］. The proportion of male children was significantly increased (74.5%, vs.54.8%, χ2=5.266, P=0.022). The proportion of children with GOS-E Peds score 5～8 was significantly higher (45.5% vs. 20.5%, χ2=9.056, P=0.003).Admission Day 1 to Day 7,there was significant difference in CO2R between the younger(0~2 years old), the middle age(3~5 years old) and the older group(＞5 years old). Compared with the younger group (t=6.689, P=0.008) and the older group (t=5.906, P=0.014), the CO2R valuein the middle age group was significantly higher.Compared with the older group (t=16.227, P<0.001),the CO2R value was significantly lower in the younger group.The CO2R of male children was significantly lower than that of female children (t=5.708, P=0.019). The male children had a lower average mean CO2R value.At the CO2R monitoring Day 6 after the recovery of children, this comparison reversed.Compared with the better prognosis group, the CO2R of the children with poor prognosis was significantly lower (t=4.572, P=0.046).Logistic regression analysis showed that the lower mean CO2R was an independent risk factor for poor prognosis in TBI children (OR=1.188, 95% CI 1.045~1.340, P=0.016). Conclusion: TBI children CO2R damage occurs in a higher proportion. CO2R damage is unfavorable to the prognosis of TBI children. The age and gender have significant effect on CO2R changes in children with TBI, and the lower CO2R is correlated with the prognosis of TBI children.
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Received: 15 June 2017
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| About author:: Cao Hai-wei,E-mail:chwhnkf@sina.com |
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