Invasive intracranial pressure monitoring is a useful adjunct in the management of severe XXXX associated with pediatric @entity879 .

@entity1 @entity2656 @entity932 @entity2657 @entity4215 @entity428 @entity510 @entity879 @entity75 @entity2067 @entity1003 @entity281 @entity2507 @entity881 @entity99 @entity775
OBJECTIVE: Pediatric @entity879 is often accompanied by @entity99 , @entity2657 , and @entity428 . @entity428 can be managed more effectively with intracranial monitoring, but acute-liver-failure-associated @entity1003 is often considered a contraindication for invasive monitoring due to risk for @entity510 . We reviewed our experience with use of early intracranial pressure monitoring in @entity879 in @entity1 listed for liver transplantation. DESIGN AND @entity1 : Retrospective review of all intubated pediatric @entity879 @entity1 with grade III and grade IV @entity75 requiring intracranial pressure monitoring and evaluated for potential liver transplant who were identified from an institutional liver transplant @entity1 database from 1999 to 2009. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 14 @entity1 were identified who met the inclusion criteria. Their ages ranged from 7 months to 20 yrs. Diagnoses of @entity879 were infectious (three), drug-induced (seven), @entity775 (two), and indeterminate (two). Grade III and IV @entity75 was seen in ten (71%) and four (29%) @entity1 , respectively. Computed tomography scans before intracranial pressure monitor placement showed @entity2657 in five (35.7%) @entity1 . Before intracranial pressure monitor placement, fresh frozen plasma, @entity2067 , and activated recombinant factor VIIa were given to all 14 @entity1 , with significant improvement in @entity1003 (p < .04). The initial intracranial pressure ranged from 5 to 50 cm @entity2507 ; the intracranial pressure was significantly higher in @entity1 with @entity2657 by computed tomography (p < .05). Eleven of 14 (78%) @entity1 received hypertonic saline, and three (22%) received @entity2656 for @entity428 . Eight of 14 (56%) monitored @entity1 were managed to liver transplant, with 100% surviving neurologically intact. Four of 14 (28%) @entity1 had spontaneous recovery without liver transplant. Two of 14 (14%) @entity1 died due to @entity881 before transplant. One @entity1 had a small 9-mm @entity932 but survived after receiving a liver transplant. No @entity1 developed @entity281 . CONCLUSIONS: In our series of @entity1 , intracranial pressure monitoring had a low complication rate and was associated with a high survival rate despite severe @entity99 and @entity2657 in the setting of pediatric @entity879 . In our experience, monitoring of intracranial pressure allowed interventions to treat @entity428 and provided additional information regarding central @entity4215 before liver transplant. Further study is warranted to confirm if monitoring allows more directed intracranial pressure therapy and improves survival in pediatric @entity879 .
