The Development of a Dashboard to Optimise Neuromonitoring of Paediatric Traumatic Brain Injury Patients in the Intensive Care Unit

The Development of a Dashboard to Optimise Neuromonitoring of Paediatric Traumatic Brain Injury Patients in the Intensive Care Unit

Formsma, Bart (TU Delft Mechanical, Maritime and Materials Engineering)

Kuiper, Jan Willem (mentor)
Schouten, A.C. (graduation committee)
de Jonge, Rogier (graduation committee)
van Twist, Eris (graduation committee)

Delft University of Technology
Erasmus Universiteit Rotterdam
Universiteit Leiden

Technical Medicine | Sensing and Stimulation

2022-12-09

Introduction Traumatic brain injury (TBI) is a leading cause of childhood morbidity, disability and mortality worldwide. In the treatment of TBI, neuromonitoring is essential to prevent secondary neurological damage. However, the use of neuromonitoring and specifically therapeutic targets is currently limited evidence-based.
Objective The primary objective is to implement suitable neuromonitoring parameters into a novel bedside dashboard for paediatric TBI patients. In addition, basic insights into neuromonitoring parameters between different outcome groups are provided.
Methods Intracranial pressure (ICP), cumulative ICP (ICP_cum), cerebral perfusion pressure (CPP), pressure reactivity index (PRx), wavelet transform PRx, optimal CPP (CPP_opt), partial pressure of arterial oxygen (P_aO₂), partial pressure of arterial carbon dioxide (P_aCO₂), end tidal CO2 (etCO₂), temperature and sodium levels were implemented into a dashboard. The parameters (except wPRx) were retrospectively analysed in TBI patients admitted to the paediatric intensive care unit (PICU) of the Erasmus MC- Sophia. Patients were divided into a good (GO) or bad (BO) outcome group. Per outcome group, the mean and 95 % confidence interval or the median and interquartile range of parameters were calculated.
Results A total of 35 patients (24 GO, 11 BO) were included. Significant differences between GO and BO were observed in median PRx (-0.06 [-0.13 – 0.01] vs. 0.17 [-0.05 – 0.39]), median percentage outside of the CPP_opt (curve) range (15 % [4 – 26] vs. 30 % [26 – 34]), ICP_cum distributions (12.0 mmHg [8.0 – 16.0] vs. 12.0 mmHg [8.5 – 15.5]) and mean sodium levels (146.4 mmol/L (144.5 – 148.3) vs. 151.2 mmol/L (148.6 – 153.8)).
Conclusion In a retrospective analysis, PRx, CPP_opt (curve) and ICP_cum showed potential to improve prognostication for paediatric TBI and to determine therapeutic targets. Based on our results, we recommend implementing MAP, ICP, ICP_cum, CPP alongside CPP_opt (curve), and sodium levels in a future neuromonitoring dashboard.

Neuromonitoring
Paediatric traumatic brain injury
Paediatric Intensive Care Unit

http://resolver.tudelft.nl/uuid:39092c92-a849-4eb0-9649-8356ec5798f1

Student theses

master thesis

© 2022 Bart Formsma