Intracranial pressure monitoring as a guide to prognosis in the nearly drowned, severely comatose child.

During a 34-month-period, 55 nearly drowned, comatose children who were admitted to our pediatric intensive care unit were divided into C1 (decorticate), C2 (decerebrate), and C3 (flaccid) subgroups. Patients in subgroup C3 were selected for intracranial pressure (ICP) measurements by the subarachnoid bolt, and were reclassified according to clinical outcome into recovered (group A), fatality (group B), and brain damaged (group C) categories. Six children (29%) had complete recovery, 10 died (48%), and five (23%) demonstrated residual brain damage. There was a highly significant difference between the ICP in group A and group B (P less than 0.001), and between group B and group C (P less than 0.001). Both group A and group C had highly significant differences in mean cerebral perfusion pressure (CPP) values compared with group B (P less than 0.001). There were no significant differences in ICP or CPP between groups A and C. Finally, using a combination of ICP and CPP, we found that ICP less than or equal to 20 mm Hg and CPP greater than or equal to 50 mm Hg were associated with survival in 11 of 12 patients (92%), whereas ICP greater than 20 mm Hg and CPP less than 50 mm Hg were associated with death in seven patients cases (100%). The two other patients who died had either CPP less than 50 mm Hg or ICP greater than 20 mm Hg, but not both. We find that intracranial pressure monitoring is a safe, useful tool in predicting death or survival, but not residual brain damage, in the nearly drowned, severely comatose child.