Cerebral perfusion in children with severe infections of the central nervous system

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BACKGROUND

Adequate cerebral perfusion is a major challenge in ICU children with severe infections of the central nervous system (CNS).

OBJECTIVE

To establish the optimal indicators of systemic and cerebral perfusion in children with CNS infections and catecholamine support.

MATERIAL AND METHODS

There were 100 children aged 3.5±2.6 years with severe CNS infections. GCS score at admission was 8.8±2.4 points. To assess the effectiveness of cerebral perfusion, we measured optic nerve diameter and performed transcranial Doppler neurosonography with calculation of resistance index in the middle cerebral artery. Oxygen saturation in brain parenchyma was assessed in 30 patients by using of cerebral oximetry. We measured transverse dimensions of hemispheres and lateral ventricles in all patients. All examinations were conducted in 1, 3 and 5 days after admission to ICU.

RESULTS

The only significant indicator was resistance index in the middle cerebral artery. This value was significantly higher in deceased patients (0.65±0.11 vs 0.48±0.16; p<0.05). A correlation between optic disc diameter and GCS score was revealed (R=0.52; p<0.005). Severity of cardiovascular dysfunction correlated with resistance index in the middle cerebral artery (R=0.61; p<0.005). Optic disc diameter was not associated with outcomes of disease. Optimal cerebral perfusion is observed in patients with mean blood pressure 55—75 mm Hg.

CONCLUSION

Mean blood pressure should be maintained within 55—75 mm Hg in children with severe CNS infections requiring hemodynamic support.

Keywords:

CNS infections

children

intracranial hypertension

cerebral perfusion

Authors:

K.Yu. Ermolenko

Children’s Research Clinical Center for Infectious Diseases;
St. Petersburg State Pediatric Medical University

ORCID: 0000-0003-1628-1698

K.V. Pshenisnov

Children’s Scientific Clinical Center for Infectious Diseases

ORCID: 0000-0003-1113-5296

Yu.S. Aleksandrovich

Children’s Scientific Clinical Center for Infectious Diseases

ORCID: 0000-0002-2131-4813

Yu.P. Vasilieva

Children’s Research Clinical Center for Infectious Diseases

ORCID: 0000-0002-4732-8623

Received:

31.01.2023

Accepted:

28.03.2023

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