Paediatric Intensive Care Unit, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Pediatr Crit Care Med. 2012 Jan;13(1):e39-47. doi: 10.1097/PCC.0b013e31820ac2ad.
To determine the effect of and dynamic interaction between head elevation on intracranial pressure and cerebral perfusion pressure in severe pediatric traumatic head injury.
Prospective, randomized, interventional cohort study.
Two tertiary pediatric critical care referral units.
Ten children admitted with severe traumatic brain injury defined as Glasgow Coma Score ≤ 8 necessitating intracranial pressure monitoring (10 yrs ± 5 SD; range 2-16 yrs).
Head elevation was randomly increased or decreased between 0 and 40 degrees from baseline level (30 degrees) in increments or decrements of 10 degrees.
Intracranial pressure and arterial blood pressure were continuously recorded in combination with time-stamped clinical notations. Data were available for analysis in eight subjects (seven males and one female; mean age, 10 yrs ± SD 5; range, 2-16 yrs) during 18 protocol sessions. This resulted in a total of 66 head-of-the-bed challenges. To compare results for a given change in head-of-the-bed elevation across age, we transformed head-of-the-bed angle to change in height (cm) at the level of Monro's foramen. An increase in head elevation of 10 cm resulted in an average change in intracranial pressure of -3.9 mm Hg (SD ± 3.2 mm Hg; p < .001), whereas cerebral perfusion pressure remained unchanged (0.1 ± 5.6 mm Hg; p = .957). Individual subjects showed marked variability in intracranial pressure change (range, -8.4 to +1.9 mm Hg/10 cm). The overall regression analysis for intracranial pressure response was change in intracranial pressure = -0.39/cm Δh, r2 = 0.42, and p < .001, where Δh is the change in vertical height at the level of foramen of Monro attributable to a change in the head of the bed.
In severe pediatric traumatic brain injury, the relationship between change in head of the bed and change in intracranial pressure was negative and linear. The lowest intracranial pressure was usually, but not always, achieved at highest head-of-the-bed angles. The effect size of a head-of-the-bed angle change depended, in part, on the subject's height. In contrast, cerebral perfusion pressure was mostly unaffected by head-of-the-bed changes.
确定头高位对颅内压和脑灌注压的影响及其动态相互作用在严重儿科创伤性颅脑损伤中的作用。
前瞻性、随机、干预性队列研究。
两家三级儿科重症监护转诊单位。
10 名因严重创伤性脑损伤而入院的儿童，格拉斯哥昏迷评分≤8，需要颅内压监测（10 岁±5 标准差；年龄 2-16 岁）。
从基线水平（30 度）将头抬高或降低 0 至 40 度，增量或减量为 10 度。
连续记录颅内压和动脉血压，并结合时间标记的临床记录。在 18 个方案会议期间，8 名受试者（7 名男性和 1 名女性；平均年龄 10 岁±SD 5；年龄 2-16 岁）可进行数据分析。这总共产生了 66 个头高位挑战。为了比较给定头高位变化在不同年龄组的结果，我们将头高位角度转换为 Monro 孔水平的高度变化（cm）。头抬高 10cm 平均导致颅内压变化-3.9mmHg（SD±3.2mmHg；p<.001），而脑灌注压保持不变（0.1±5.6mmHg；p=0.957）。个别患者的颅内压变化差异很大（范围-8.4 至+1.9mmHg/10cm）。颅内压反应的整体回归分析为颅内压变化= -0.39/cmΔh，r2=0.42，p<.001，其中Δh 是由于头位改变导致的 Monro 孔水平垂直高度的变化。
在严重儿科创伤性脑损伤中，头位变化与颅内压变化之间的关系为负线性。颅内压最低通常（但不总是）在最高头高位时达到。头高位角度变化的效应大小部分取决于受试者的身高。相比之下，脑灌注压受头位变化的影响较小。
