Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury

Introduction Brain tissue oxygen tension (PbtO₂) monitoring is used increasingly in adult severe traumatic brain injury (TBI) management. Several factors are known to influence PbtO₂ in adults, but the variables that affect PbtO₂ in pediatric TBI are not well described. This study examines the relationships between PbtO₂ and (1) physiological markers of potential secondary insults commonly used in pediatric TBI, in particular intracranial pressure (ICP), cerebral perfusion pressure (CPP), and systemic hypoxia, and (2) other clinical factors and treatment received that may influence PbtO₂. Materials and methods In this prospective observational study, 52 children (mean age, 6.5 ± 3.4 years; range, 9 months to 14 years old) with severe TBI and a median post-resuscitation Glasgow Coma Score (GCS) of 5 were managed with continuous PbtO₂ monitoring. The relationships between PbtO₂ parameters ( [graphic removed] , PbtO₂ < 5, PbtO₂ < 10, and [graphic removed] ) and clinical, physiological, and treatment factors were explored using time-linked data and Spearman's correlation coefficients. Results No clinical, physiological, or treatment variable was significantly associated with all PbtO₂ parameters, but individual associations were found with initial GCS (PbtO₂ < 5, p = 0.0113), admission Pediatric Trauma Score (PbtO₂ < 10, 0.0175), mICP > 20 ( [graphic removed] , p = 0.0377), CPPlow ( [graphic removed] , p = 0.0065), CPP < 40 ( [graphic removed] , p = 0.0269; PbtO₂ < 5, p = 0.0212), PaO₂ < 60 ( [graphic removed] , p = 0.0037), SaO₂ < 90 ( [graphic removed] , p = 0.0438), and use of inotropes during ICU care ( [graphic removed] , p = 0.0276; PbtO₂ < 10, p = 0.0277; p = [graphic removed] ). Conclusion Delivery of oxygen to the brain is important to limit secondary neuronal injury after severe TBI. Our data show that PbtO₂ is poorly predicted by clinical and physiological factors commonly measured in the pediatric ICU. Multimodality monitoring may be needed to detect all secondary cerebral insults in pediatric TBI.