Researchers refine brain injury guidelines for children

When a child is suffering from head trauma, health professionals are at full speed to avoid further damage to the developing brain. Measuring and regulating the child's carbon dioxide level is essential to ensure that the brain receives enough oxygen in the blood to prevent secondary brain injury. High levels of carbon dioxide can increase intracranial pressure, while a low level is associated with poor circulation of the brain.

The Harborview Injury Prevention and Research Center (HIPRC) has developed a protocol for a standardized response to these events. The guidelines, released earlier this year, are being used at Harborview Medical Center, the region's Level I pediatric trauma center, where approximately 120 traumatized brain patients undergo care each year.

But there is no indication that a non-invasive method of measuring carbon dioxide from patient exhalation, called end-tidal capnography, is as effective as blood in the artery of a child.

In a study published August 16 in JAMA, HIPRC researchers answered this clinical question: Measuring the level of carbon dioxide through an artery remains the most accurate diagnosis for brain trauma in the child.

"To maintain proper levels of carbon dioxide, we must always use the standard approach," said Dr. Jen-Ting Yang, Associate Physician in Anesthesiology and Pain Medicine at the Faculty of Medicine at the University of Toronto. 39, University of Washington.

The sampling of carbon dioxide in the artery is considered the gold standard, but the end-of-tidal carbon dioxide is widely used in clinical practice because placing a line in a child's artery is a challenge and complications are not uncommon.

In a study of two ways to detect carbon dioxide, Yang and his colleagues found a weak agreement between the use of an arterial line and capnography at the end of the tide. The researchers analyzed the cases of 137 children under 18 admitted to the Harborview Pediatric ICU between 2011 and 2017. Among these children, the researchers had 445 matched data points from both diagnostic methods. .

Overall, only 42% of the matched data agreed (187 out of 445 data points). The concordance was even lower during the first eight hours after admission and with the onset of acute respiratory distress syndrome in the child.

Monica Vavilala, Director of HIPRC and Professor of Anesthesiology and Pain Management at the University of Washington, reported that, given the frequency with which clinicians used carbon dioxide levels derived from extreme tides to adjust the ventilation parameters, the researchers hoped that tidal capnography would be just as effective. But, she says, she is happy that they have been able to identify the preferred method.

"We have been able to use the evidence provided by traumatized brain patients to establish a better roadmap for what has been agreed to as good quality care," she said.