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783 Management of Severe Paediatric Trauma Brain Injury (PTBI) Guided by Intracranial Pressure (ICP) Monitoring in a Picu in Algeria
  1. H Bouguetof,
  2. MA Negadi,
  3. K El Halimi,
  4. D Boumendil,
  5. ZC Mentouri
  1. Pediatric Intensive Care Unit, Faculty of Medicine - Oran University, Oran, Algeria

Abstract

Background and Aims PTBI is the leading cause of death and long-term morbidity. Current recommendations for the management of severe PTBI (Glasgow Coma [GCS] score ≤8) indicate that ICP monitoring is appropriate in infants and children (Option). The most reliable methods of ICP monitoring are ventricular catheters and intra parenchymal systems. The aim of this study is to evaluate the management of PTBI based on continues monitoring of intraparenchymal ICP in a PICU in Algeria.

Methods Between January 2005 and December 2009 we collected 308 PTBI, 57 patients had intraparenchymal ICP monitoring. The consensus is to treat ICP exceeding the 20 mmHg threshold, and to optimize cerebral perfusion pressure (CPP).

Results The mean age was 8 years, hypoxia and hypotension were frequent at admission, median GCS after resuscitation = 6, ICP monitoring was set up by the intensivist in the PICU after un average time of 13 hours after trauma. Intracranial hypertension was detected and treated (mannitol, hyerventilation and thiopental) in more than 90% of cases. the average time of ICP monitoring was 5 days. No complications (infection, hemorrhage) with this technique was detected.

Conclusion The etiology and the pathophysiology of raised ICP in PTBI is a complex challenge for the intensivist. CPP and ICP were the first brain-specific targets for goal-directed therapies enacted in PTBI. In this study, ICP monitoring allows to detect intracranial hypertension and guide treatment better than when this technique is absent even if it is not a standard of the recommendations.

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