{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T01:32:38Z","timestamp":1772155958583,"version":"3.50.1"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2021,12]]},"abstract":"\n Background<\/jats:title>\n \n Intubated pediatric patients with isolated traumatic brain injury (TBI) are a diagnostic challenge for early detection of altered cerebral physiology instigated by trauma-induced increased intracranial pressure (ICP) while preventing secondary neuronal damage (secondary insult detection) and assessing the effects of increased ICP therapeutic interventions (3% hypertonic saline [HTS]). Invasive brain tissue oxygen monitoring is guiding new intensive care unit TBI management but is not pediatric emergency department (PED) readily accessible. Objective measurements on pediatric isolated TBI-altered bihemispheric cerebral physiology and treatment effects of 3% HTS are currently lacking. Cerebral oximetry can assess increased ICP-induced abnormal bihemispheric cerebral physiology by measuring regional tissue oxygenation (r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n ) and cerebral blood volume index (CBVI) and the mechanical cerebrospinal fluid removal effects on the increased ICP-induced abnormal bihemispheric cerebral physiology.\n <\/jats:p>\n \n In the PED intubated patients with isolated TBI, assessing the 3% HTS therapeutic response is solely by vital signs and limited clinical assessment skills. Objective measurements of the 3% HTS hyperosmolar effects on the PED isolated TBI patients' altered bihemispheric cerebral physiology are lacking. We believe that bihemispheric r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n and CBVI could elucidate similar data on 3% HTS impact and influence in the intubated isolated TBI patients.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n This study aimed to analyze the effects of 3% HTS on bihemispheric r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n and CBVI in intubated patients with isolated TBI.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n An observational, retrospective analysis of bihemispheric r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n and CBVI readings in intubated pediatric patients with isolated TBI receiving 3% HTS infusions, was performed.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n From 2010 to 2017, 207 intubated patients with isolated TBI received 3% HTS infusions (median age, 2.9 [1.1\u20136.9 years]; preintubation Glasgow Coma Scale score, 7 [6\u20138]). The results were as follows: initial pre\u22123% HTS, 43% (39.5% to 47.5%; left) and 38% (35% to 42%; right) for r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n < 60%, and 8 (\u221228 to 21; left) and \u221215 (\u221234 to 22; right) for CBVI; post\u20133% HTS, 68.5% (59.3% to 76%,\n P<\/jats:italic>\n < 0.0001; left) and 62.5% (56.0% to 74.8%,\n P<\/jats:italic>\n < 0.0001; right) for r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n < 60%, and 12 (\u22127 to 24,\n P<\/jats:italic>\n = 0.04; left) and 14 (\u221221 to 22,\n P<\/jats:italic>\n < 0.0001; right) for CBVI; initial pre\u20133% HTS, 90% (83% to 91%; left) and 87% (82% to 92%; right) for r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n > 80%, and 16.5 (6 to 33,\n P<\/jats:italic>\n < 0.0001; left) and 16.8 (\u22122.5 to 27.5,\n P<\/jats:italic>\n = 0.005; right) for CBVI; and post\u20133% HTS, 69% (62% to 72.5%,\n P<\/jats:italic>\n < 0.0001; left) and 63% (59% to 72%,\n P<\/jats:italic>\n < 0.0001; right) for r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n > 80%, and 16.5 (6 to 33,\n P<\/jats:italic>\n < 0.0001; left) and 16.8 (\u22122.5 to 27.5,\n P<\/jats:italic>\n = 0.005; right) for CBVI. The following results for cerebral pathology pre\u20133% HTS were as follows: epidural: 85% (58% to 88.5%) for left r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n and \u22129.25 (\u221234 to 19) for left CBVI, and 85.5% (57.5% to 89%) for right r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n and \u221212.5 (\u221221 to 27) for CBVI; subdural: 45% (38% to 54%) for left r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n and \u22129.5 (\u221225 to 19) for left CBVI, and 40% (33% to 49%) for right r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n and \u221215 (\u221230.5 to 5) for CBVI. The following results for cerebral pathology post\u20133% HTS were as follows: epidural: 66% (58% to 69%,\n P<\/jats:italic>\n = 0.03) for left r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n and 15 (\u22121 to 21,\n P<\/jats:italic>\n = 0.0004) for left CBVI, and 63% (52% to 72%,\n P<\/jats:italic>\n = 0.009) for right r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n , and 15.5 (\u221222 to 24,\n P<\/jats:italic>\n = 0.02) for CBVI; subdural: 63% (56% to 72%,\n P<\/jats:italic>\n < 0.0001) for left r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n and 9 (\u221220 to 22,\n P<\/jats:italic>\n < 0.0001) for left CBVI, and 62.5% (48% to 73%,\n P<\/jats:italic>\n < 0.0001) for right r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n , and 3 (\u221226 to 22,\n P<\/jats:italic>\n < 0.0001) for CBVI. Overall, heart rate showed no significant change. Three percent HTS effect on interhemispheric r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n difference >10 showed r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n < 60%, and subdural hematomas had the greatest reduction (\n P<\/jats:italic>\n < 0.001). The greatest positive changes occurred in bihemispheric or one-hemispheric r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n < 60% with an interhemispheric discordance r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n > 10 and required the greatest number of 3% HTS infusions. For 3% HTS 15% r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n change time effect, all patients achieved positive change with subdural hematomas and hemispheric r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n readings <60% with the shortest achievement time of 1.2 minutes (0.59\u20131.75;\n P<\/jats:italic>\n < 0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n In intubated pediatric patients with isolated TBI who received 3% HTS infusions, bihemispheric r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n and CBVI readings immediately detected and trended the 3% HTS effects on the trauma-induced cerebral pathophysiology. The 3% HTS infusion produced a significant improvement in r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n and CBVI readings and a reduction in interhemispheric r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n discordance differences. In patients with bihemispheric or one-hemispheric r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n readings <60% with or without an interhemispheric discordance, r\n c<\/jats:sub>\n SO\n 2<\/jats:sub>\n > 10 demonstrated the greatest significant positive delta change and required the greatest numbers of 3% HTS infusions. Overall, 3% HTS produced a significant positive 15% change within 2.1 minutes of infusion, whereas heart rate showed no significant change. During trauma neuroresuscitation, especially in intubated isolated TBI patients requiring 3% HTS, cerebral oximetry has shown its functionality as a rapid adjunct neurological, therapeutic assessment tool and should be considered in the initial emergency department pediatric trauma neurological assessment and neuroresuscitation regimen.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/pec.0000000000001959","type":"journal-article","created":{"date-parts":[[2020,2,27]],"date-time":"2020-02-27T12:13:39Z","timestamp":1582805619000},"page":"e791-e804","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Assessing the Impact of 3% Hypertonic Saline Hyperosmolar Therapy on Intubated Children With Isolated Traumatic Brain Injury by Cerebral Oximetry in a Pediatric Emergency Setting"],"prefix":"10.1097","volume":"37","author":[{"given":"Leigh-Ann","family":"Washer","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Arkansas for Medical Sciences"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Abramo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Arkansas for Medical Sciences"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hailey","family":"Hardgrave","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences, Little Rock, AR"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zena Leah","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Feinberg School of Medicine, Northwestern Medicine, Lurie Children's Hospital, Chicago, IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Meredith","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Tennessee, LeBonheur Children's Hospital, Memphis, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Moore","sequence":"additional","affiliation":[{"name":"University of Arkansas for Medical Sciences, Little Rock, AR"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abudulah","family":"Dalabih","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Arkansas for Medical Sciences"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Williams","sequence":"additional","affiliation":[{"name":"Arkansas Children's Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Jorgenson-Stough","sequence":"additional","affiliation":[{"name":"Arkansas Children's Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee","family":"Crawley","sequence":"additional","affiliation":[{"name":"Arkansas Children's Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2020,2,27]]},"reference":[{"key":"bib1-20250504","article-title":"Pre-trauma center management of intracranial pressure in severe pediatric traumatic brain injury","year":"2016","journal-title":"Pediatr Emerg"},{"key":"bib2-20250504","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1007\/s00134-007-0889-3","article-title":"Hypoxia and hypotension, the \u201clethal duo\u201d in traumatic brain injury: implications for prehospital care","volume":"34","year":"2008","journal-title":"Intensive Care Med"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1001\/jamasurg.2016.4686","article-title":"Mortality and prehospital blood pressure in patients with major traumatic brain injury: implications for the hypotension threshold","volume":"152","year":"2017","journal-title":"JAMA Surg"},{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1007\/s00134-016-4401-9","article-title":"Severe traumatic brain injury in children: a vision for the future","volume":"42","year":"2016","journal-title":"Intensive Care Med"},{"key":"bib5-20250504","first-page":"408","article-title":"Cerebral metabolism following traumatic brain injury: new discoveries with implications for treatment","volume":"8","year":"2015","journal-title":"Front Neurosci"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1227\/NEU.0b013e318243fc59","article-title":"The relationship between intracranial pressure and brain oxygenation in children with severe traumatic brain injury","volume":"70","year":"2012","journal-title":"Neurosurgery"},{"key":"bib7-20250504","doi-asserted-by":"crossref","first-page":"672","DOI":"10.3171\/2009.4.JNS081150","article-title":"Brain tissue oxygen monitoring in traumatic brain injury and major trauma: outcome analysis of a brain tissue oxygen-directed therapy","volume":"111","year":"2009","journal-title":"J Neurosurg"},{"key":"bib8-20250504","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1177\/0885066614529254","article-title":"Brain tissue oxygen monitoring in neurocritical care","volume":"30","year":"2015","journal-title":"J Intensive Care Med"},{"key":"bib9-20250504","doi-asserted-by":"crossref","first-page":"901","DOI":"10.3171\/2013.12.JNS131089","article-title":"Assessment of a noninvasive cerebral oxygenation monitor in patients with severe traumatic brain injury","volume":"120","year":"2014","journal-title":"J Neurosurg"},{"key":"bib10-20250504","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1089\/neu.2014.3748","article-title":"Near-infrared spectroscopy in the monitoring of adult traumatic brain injury: a review","volume":"32","year":"2015","journal-title":"J Neurotrauma"},{"key":"bib11-20250504","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1089\/neu.2011.1890","article-title":"The utility of near infrared spectroscopy in detecting intracranial hemorrhage in children","volume":"29","year":"2012","journal-title":"J Neurotrauma"},{"key":"bib12-20250504","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1016\/j.ajem.2016.03.005","article-title":"Cerebral oximetry with blood volume index and capnography in intubated and hyperventilated patients","volume":"34","year":"2016","journal-title":"Am J Emerg Med"},{"key":"bib13-20250504","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research Electronic Data Capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","year":"2009","journal-title":"J Biomed Inform"},{"key":"bib14-20250504","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1227\/01.NEU.0000359533.16214.04","article-title":"Hypertonic saline and its effect on intracranial pressure, cerebral perfusion pressure, and brain tissue oxygen","volume":"65","year":"2009","journal-title":"Neurosurgery"},{"key":"bib15-20250504","first-page":"273","article-title":"An update on cerebral oxygenation monitoring, an innovative application in cardiac arrest and neurological emergencies","year":"2015","journal-title":"Annu Update Intensive Care Emerg Med"},{"key":"bib16-20250504","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.ajem.2013.10.047","article-title":"Cerebral oxygen saturation monitoring in pediatric altered mental status patients","volume":"32","year":"2014","journal-title":"Am J Emerg Med"},{"key":"bib17-20250504","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1097\/PEC.0000000000000141","article-title":"Innovative application of cerebral rSO2 monitoring during shunt tap in pediatric ventricular malfunctioning shunts","volume":"31","year":"2015","journal-title":"Pediatr Emerg Care"},{"key":"bib18-20250504","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1016\/j.ajem.2015.07.037","article-title":"Cerebral oximetry with cerebral blood volume index in detecting pediatric stroke in a pediatric ED","volume":"33","year":"2015","journal-title":"Am J Emerg Med"},{"key":"bib19-20250504","doi-asserted-by":"crossref","first-page":"2720","DOI":"10.1161\/01.STR.0000244807.99073.ae","article-title":"Tissue oxygen index: thresholds for cerebral ischemia using near-infrared spectroscopy","volume":"37","year":"2006","journal-title":"Stroke"},{"issue":"suppl 5","key":"bib20-20250504","first-page":"S2","article-title":"Tissue hemoglobin index: a non-invasive optical measure of total tissue hemoglobin","volume":"13","year":"2009","journal-title":"Crit Care"},{"key":"bib21-20250504","first-page":"S133","article-title":"Hypertonic saline and the microcirculation","volume":"54","year":"2003","journal-title":"J Trauma"},{"key":"bib22-20250504","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1089\/neu.2006.0031","article-title":"Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study","volume":"24","year":"2007","journal-title":"J Neurotrauma"},{"key":"bib23-20250504","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1007\/s00134-007-0863-0","article-title":"Posttraumatic brain vulnerability to hypoxia-hypotension: the importance of the delay between brain trauma and secondary insult","volume":"34","year":"2008","journal-title":"Intensive Care Med"},{"key":"bib24-20250504","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1007\/s00381-012-1837-2","article-title":"The frequency of cerebral ischemia\/hypoxia in pediatric severe traumatic brain injury","volume":"28","year":"2012","journal-title":"Childs Nerv Syst"},{"key":"bib25-20250504","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1097\/CCM.0000000000002619","article-title":"Brain oxygen optimization in severe traumatic brain injury phase-II: a phase II randomized trial","volume":"45","year":"2017","journal-title":"Crit Care Med"},{"key":"bib26-20250504","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/978-3-319-22533-3_2","article-title":"Early changes in brain oxygen tension may predict outcome following severe traumatic brain injury","volume":"122","year":"2016","journal-title":"Acta Neurochir Suppl"},{"key":"bib27-20250504","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1097\/MAJ.0000000000000506","article-title":"Traumatic brain injury and mitochondrial dysfunction","volume":"350","year":"2015","journal-title":"Am J Med Sci"},{"key":"bib28-20250504","doi-asserted-by":"crossref","first-page":"678","DOI":"10.3171\/JNS\/2008\/109\/10\/0678","article-title":"Relationship of \u201cdose\u201d of intracranial hypertension to outcome in severe traumatic brain injury","volume":"109","year":"2008","journal-title":"J Neurosurg"},{"key":"bib29-20250504","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1227\/01.NEU.0000313113.43447.0C","article-title":"Does adherence to treatment targets in children with severe traumatic brain injury avoid brain hypoxia? A brain tissue oxygenation study","volume":"63","year":"2008","journal-title":"Neurosurgery"},{"key":"bib30-20250504","doi-asserted-by":"crossref","first-page":"383","DOI":"10.3171\/2012.8.PEDS12165","article-title":"Brain tissue oxygen monitoring after severe traumatic brain injury in children: relationship to outcome and association with other clinical parameters","volume":"10","year":"2012","journal-title":"J Neurosurg Pediatr"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000001959","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T16:04:05Z","timestamp":1746374645000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000001959"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,27]]},"references-count":30,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000001959","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.737479813.793583750","asserted-by":"object"}]},"ISSN":["1535-1815","0749-5161"],"issn-type":[{"value":"1535-1815","type":"electronic"},{"value":"0749-5161","type":"print"}],"subject":[],"published":{"date-parts":[[2020,2,27]]}}}