Introduction:Trauma is the commonest cause of death in the pediatric populati on,which is prone to diffuse primary brain injury aggravated by secondary insul ts(eg,hypoxia,hypotension).Standard monitoring involves intracranial pressur e(ICP)and cerebral perfusion pressure,which do not reflect true cerebral oxyg enation(oxygen delivery [DO2]).We explore the merits of a brain tissue oxygen-directed critical care guide.Methods:Sixteen patients with major trauma(Inj ury Severity Score,> 16/Pediatric Trauma Score [PTS],< 7)had partial pressure of brain tissue oxygen(PbtO2)monitor(Licox;Integra Neurosciences,Plainsbor o,NJ)placed under local anesthesia using twist-drill craniostomy and definiti ve management of associated injuries.PbtO2 levels directed therapy intensity level(ventilator management,inotrops,blood transfusion,and others).Patien t demographics,short-term physiological parameters,PbtO2,ICP,Glasgow Coma S core,trauma scores,and outcomes were analyzed to identify the patients at risk for low DO2.Results:There were 10 males and 6 females(mean age,14 years)su staining motor vehicle accident(14),falls(1),and assault(1),with a mean In jury Severity Score of 36(16-59);PTS,3(0-7);and Revised Trauma Score,5.5(4-11).Eleven patients(70%)had low DO2(PbtO2,< 20 mmHg)on admission des pite undergoing standard resuscitation affected by fraction of inspired oxygen,PaO2,and cerebral perfusion pressure(P =0.001).Eubaric hyperoxia improved ce rebral oxygenation in the low-DO2 group(P =0.044).The Revised Trauma Score(r = 0.65)showed moderate correlation with PbtO2 and was a significant predictor for low DO2(P =0.001).In patients with PbtO2 of less than 20 mm Hg,PTS corre lated with cerebral oxygenation(r = 0.671,P =0.033).The mean 2-hour PbtO2 a nd the final PbtO2 in survivors were significantly higher than deaths(21.6 vs 7.2 mmHg [P =0.009] and 25 vs 11mmHg [P =0.01]).Although 4 of 6 deaths were from uncontrolled high ICP,PTS and 2-hour low DO2 were significant for roots formo rtality.Conclusions:PbtO2 monitoring allows for early recognition of low-DO2 situations,enabling appropriate therapeutic intervention.
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