Eventos associados à ocorrência de hipertensão intracraniana em pacientes pediátricos com traumatismo crânio-encefálico grave e monitoração da pressão intracraniana

Abstract

Objective: to determine associated events to intracranial hypertension in pediatric severe traumatic brain injury with intracranial pressure monitoring. Methods: cohort of patients with blunt head trauma, scored less than nine in Glasgow Coma Scale and submitted to intracranial pressure monitoring, admitted in intensive care unit of João XXIII Hospital, between 2005 and 2014. Excluded those with gunshot wounds and with previous neurologic disease. Intracranial hypertension was defined like an episode of intracranial pressure above 20mmHg that required treatment. Results: 198 patients, 139 males (70,2%), between three months and eighteen years, old median 9. Ninety percent of the cases were secondary to traffic accidents. Intracranial hypertension was present in 135 patients (68,2%). The maximum ICP was, mean 36,3mmHg (median, 34mmHg). One hundred thirty three patients received analgesia and sedation for ICH (97,8%), 108, neuromuscular paralysis (79,4%), seven, cerebrospinal fluid drainage (5,2%), 105, mannitol (77,2%), 96, hyperventilation (70,6%), 64, hypertonic saline (47,1%), 20, barbiturates (14,7%), 43, decompressive craniectomy (31,9%). There was 4,9% of infectious and 4,9% of hemorrhage complications secondary to the monitoring; but no one required surgery for a device related hematoma. The odds ratio for ICH for patients with Marshall III Classification was 14 (IC95 2,8-113; p<0,003) and for Marshall IV, 24,9 (IC95 2,35-676; p<0,18). There was 27,9% of deaths in group of patients with ICH and 9,7% in group without ICH (p=0,007). The global mortality was 22,2% (44 patients). Conclusions: pediatric patients with severe traumatic head injury and tomographic Marshall Classification III and IV had high odds to develop intracranial hypertension (ICH). Intracranial hypertension was associated to unfavorable outcome. The complications of intracranial pressure monitoring were infrequent and were not severe events.