[P3-100] Blood-Gas Monitoring during therapeutic hypothermia in Children with Refractory Intracranial Hypertension
[Introduction]
Therapeutic hypothermia (TH) was known to have neuroprotective effects in patient with intracranial hypertension. Blood gas monitoring during TH is recommend in most of the guideline. We aim to analysis the blood gas change when the pediatric patients receiving TH.
[Methodology]
During 2013-2016, we collected the patient with intracranial hypertension and received TH in the PICU of Kaohsiung medical university hospital (KMUH). Clinical features, indication of ICU admission, length of ICU stay and survival rate were recorded. The duration of TH protocol was 72 hours. All patients were intubated with ventilator use and osmotherapy with continuous hypertonic saline was also prescribed. Serial blood gas analysis was collected in before TH, first hour, twelfth hour and each therapeutic day of TH.
[Results]
9 patients (mean age=6.8, SD=6.5, ranging from 2 months to 16 years) was admitted to our PICU. The causes of ICU admission are abusive head trauma (n=2), encephalitis (n=2), out-hospital cardiac arrest (n=2), carbon monoxide intoxication (n=1) and arteriovenous malformation post operation (n=1). Mean ICU stay is 22.8 days (SD=12.5). All patients survived after TH. Mean level of carbon dioxide during first hour of TH is 41.8(SD=16.8) and decreased to 36.6(SD=9.2) at the twelfth hour of TH.
[Conclusions]
For patient under ventilator use, reduction in cerebral metabolism during TH may lead to metabolic alkalosis and result in ischemia injury. We suggest to titrate the ventilator setting during the first twelfth hour of TH to maintain adequate cerebral circulation.
Therapeutic hypothermia (TH) was known to have neuroprotective effects in patient with intracranial hypertension. Blood gas monitoring during TH is recommend in most of the guideline. We aim to analysis the blood gas change when the pediatric patients receiving TH.
[Methodology]
During 2013-2016, we collected the patient with intracranial hypertension and received TH in the PICU of Kaohsiung medical university hospital (KMUH). Clinical features, indication of ICU admission, length of ICU stay and survival rate were recorded. The duration of TH protocol was 72 hours. All patients were intubated with ventilator use and osmotherapy with continuous hypertonic saline was also prescribed. Serial blood gas analysis was collected in before TH, first hour, twelfth hour and each therapeutic day of TH.
[Results]
9 patients (mean age=6.8, SD=6.5, ranging from 2 months to 16 years) was admitted to our PICU. The causes of ICU admission are abusive head trauma (n=2), encephalitis (n=2), out-hospital cardiac arrest (n=2), carbon monoxide intoxication (n=1) and arteriovenous malformation post operation (n=1). Mean ICU stay is 22.8 days (SD=12.5). All patients survived after TH. Mean level of carbon dioxide during first hour of TH is 41.8(SD=16.8) and decreased to 36.6(SD=9.2) at the twelfth hour of TH.
[Conclusions]
For patient under ventilator use, reduction in cerebral metabolism during TH may lead to metabolic alkalosis and result in ischemia injury. We suggest to titrate the ventilator setting during the first twelfth hour of TH to maintain adequate cerebral circulation.