Depression of whole-brain oxygen extraction fraction is associated with poor outcome in pediatric traumatic brain injury

We aimed to demonstrate the feasibility of whole brain oxygen extraction fraction (OEF) mapping for measuring lesion specific and regional OEF abnormalities in multiple sclerosis (MS) patients. In 22 MS patients and 11 healthy controls (HC), OEF and neural tissue susceptibility ([Formula: see text]) maps were computed from MRI multi-echo gradient echo data. In MS patients, 80 chronic active lesions with hyperintense rim on quantitative susceptibility mapping were identified, and the mean OEF and [Formula: see text] within the rim and core were compared using linear mixed-effect model analysis. The rim showed higher OEF and [Formula: see text] than the core: relative to their adjacent normal appearing white matter, OEF contrast = −6.6 ± 7.0% vs. −9.8 ± 7.8% (p < 0.001) and [Formula: see text] contrast = 33.9 ± 20.3 ppb vs. 25.7 ± 20.5 ppb (p = 0.017). Between MS and HC, OEF and [Formula: see text]were compared using a linear regression model in subject-based regions of interest. In the whole brain, compared to HC, MS had lower OEF, 30.4 ± 3.3% vs. 21.4 ± 4.4% (p < 0.001), and higher [Formula: see text], −23.7 ± 7.0 ppb vs. −11.3 ± 7.7 ppb (p = 0.018). Our feasibility study suggests that OEF may serve as a useful quantitative marker of tissue oxygen utilization in MS.

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Quantification of brain oxygen extraction fraction using QSM and a hyperoxic challenge

Magnetic Resonance in Medicine ◽

10.1002/mrm.28390 ◽

2020 ◽

Vol 84 (6) ◽

pp. 3271-3285

Author(s):

Yuhan Ma ◽

Erin L. Mazerolle ◽

Junghun Cho ◽

Hongfu Sun ◽

Yi Wang ◽

...

Keyword(s):

Oxygen Extraction Fraction ◽

Oxygen Extraction ◽

Brain Oxygen ◽

Extraction Fraction

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Clinical Features of Fever Associated With Poor Outcome in Severe Pediatric Traumatic Brain Injury

Survey of Anesthesiology ◽

10.1097/01.sa.0000255118.26279.09 ◽

2007 ◽

Vol 51 (1) ◽

pp. 23-24

Author(s):

&NA;

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Clinical Features ◽

Pediatric Traumatic Brain Injury ◽

Poor Outcome

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Abstract 153: Non-invasive Measurement of Cerebral Tissue Oxygen Extraction Fraction is Correlated with Microdialysis Brain Injury Biomarkers During Extracorporeal Cardiopulmonary Resuscitation

Circulation ◽

10.1161/circ.142.suppl_4.153 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Tiffany S Ko ◽

Julia Slovis ◽

Lindsay Volk ◽

Constantine D Mavroudis ◽

Ryan W Morgan ◽

...

Keyword(s):

Brain Injury ◽

Oxygen Extraction Fraction ◽

Oxygen Extraction ◽

Neurological Injury ◽

Tissue Oxygen ◽

Cerebral Tissue ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Glucose Content ◽

Non Invasive ◽

Extraction Fraction

Introduction: Extracorporeal membrane oxygenation (ECMO) assisted CPR (ECPR) can improve outcomes after prolonged or unsuccessful resuscitative efforts, but neurological injury remains common in survivors. The lack of routine neuromonitoring during ECPR and ECMO prohibits brain-targeted management to help improve neurological outcomes. In this study, we examine the association of non-invasive, frequency-domain diffuse optical spectroscopy (FD-DOS) measurements of cerebral tissue oxygen extraction fraction (OEF), an indicator of metabolic stress, with invasively collected brain injury biomarkers to explore the utility of this monitoring modality during ECPR. Hypothesis: FD-DOS measurement of cerebral OEF is positively correlated with biomarkers of brain injury (lactate-pyruvate ratio, LPR; glycerol). Methods: Cerebral OEF was continuously monitored by FD-DOS in nine pediatric swine (8-11 kg) who underwent 30-60 minutes of manual CPR, were cannulated for ECMO, and remained on ECMO for 22-24 hours. Cerebral pyruvate, lactate, glycerol and glucose content were measured from cerebral microdialysate samples collected hourly. The correlation between OEF and microdialysis parameters were assessed using a linear mixed-effects model incorporating subject-specific random slope and intercept effects. Significance was determined at p<0.05. Results: Microdialysis parameters from 192 samples were compared against non-invasive OEF values. OEF was significantly correlated with LPR (p=0.001), and relative change in glycerol (p=0.005) and glucose (p=0.020) concentrations from baseline. Conclusions: Non-invasive FD-DOS neuromonitoring of OEF demonstrated significant correlations with invasive brain injury biomarkers; increasing OEF was associated with elevated LPR and glycerol, and diminished glucose. FD-DOS detection of critical neurometabolic stress at the bedside may facilitate brain-targeted ECMO management after cardiac arrest.

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HYPERGLYCEMIA AND OTHER PREDICTORS OF POOR OUTCOME IN PEDIATRIC TRAUMATIC BRAIN INJURY

Pediatric Critical Care Medicine ◽

10.1097/00130478-200609000-00084 ◽

2006 ◽

Vol 7 (5) ◽

pp. 514

Author(s):

Jose Quitain ◽

Arsenia Asuncion ◽

Shonola DaSilva ◽

Ivona Sediva ◽

Richard Burns

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Pediatric Traumatic Brain Injury ◽

Poor Outcome

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Patient Characteristics and Clinical and Intraoperative Variables Affecting Outcome in Pediatric Traumatic Brain Injury

Journal of Neuroanaesthesiology and Critical Care ◽

10.1055/s-0041-1732828 ◽

2021 ◽

Author(s):

Ankur Dhanda ◽

Ashish Bindra ◽

Roshni Dhakal ◽

Siddharth Chavali ◽

Gyaninder Pal Singh ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Intensive Care ◽

Brain Injury ◽

Head Injury ◽

Median Duration ◽

Independent Predictor ◽

Patient Characteristics ◽

Pediatric Traumatic Brain Injury ◽

Poor Outcome ◽

Pediatric Tbi

Abstract Background Pediatric traumatic brain injury (TBI) has distinctive pathophysiology and characteristics that differ from adults. These can be attributed to age-related anatomical and physiological differences and distinct patterns of injuries seen in children. Our aim was to identify the patient characteristics, clinical variables during intensive care and intraoperative management associated with poor functional outcome in a cohort of pediatric TBI patients. Methods Retrospective chart review of pediatric TBI patients admitted to neurotrauma intensive care unit (NICU) over a period of 1 year. Results A total of 105 children (< 12 years) with head injury were admitted in the NICU during the study period. The most common mechanism of injury was fall in 78% cases. Fifty-four patients (51.4%) presented with a severe head injury (Glasgow coma scale [GCS] ≤ 8), while 31 (29.5%) and 20 (19.1%) had a mild and moderate head injury. The most common finding was skull fractures (59%), contusions (36.2%), and subdural hematoma (SDH) (30.4%). Forty nine patients (46.7%) required surgical management. The median duration of anesthesia was 205 (interquartile range [IQR] 65, 375) minutes, and median blood loss during the surgery was 16.7 mL/kg body weight with 41% requiring intraoperative blood transfusions. Median duration of ICU and hospital stay was 5 (IQR 1, 47) and 8 (IQR 1, 123) days, respectively. GOS at discharge ≤ 3 representing poor outcome was present in 35 patients (33.3%). Mortality was seen in 15 (14.3%) patients. Multivariate analysis identified postresuscitation GCS ≤ 8 on admission as independent predictor of mortality, and postresuscitation GCS ≤ 8 on admission and NICU stay of > 7 days as independent predictor of poor outcome. Conclusion Despite advances in neurointensive care, mortality and morbidity remains high in pediatric head trauma and is mainly dependent on postresuscitation GCS and NICU stay of more than 7 days. Multidimensional approach is required for its prevention and management.

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