Abstract P-511: WHEN IS THE OPTIMAL TIME TO WAKE A BRAIN TRAUMA PATIENT IN THE PAEDIATRIC INTENSIVE-CARE UNIT (PICU): A DATA-INFORMATICS APPROACH
T.Y.M. Lo, Ian Piper, Greg Black, Emily J. Sullivan, Roddy O’Kane, R. Levin · Pediatric Critical Care Medicine · 2018
Aims & Objectives: The optimal timing to stop muscle relaxant and progress the intensive-care management of critically-ill traumatic brain injury (TBI) patients remains unknown. We aim to define optimal timing to progress brain trauma patients’ intensive care management using routinely generated clinical data. Methods A retrospective analysis of prospectively-collected anonymised data from TBI patients in two Scottish PICU was performed. The data analysed included physiological data, detailed annotations regarding when muscle relaxant was stopped, last intervention delivered for raised intracranial pressure (ICP) or reduced cerebral perfusion pressure (CPP), blood gas results, sedation use etc. Patients were dichotomised into ‘successful clinical progression’ and ‘failed clinical progression’ depending upon if muscle relaxant was restarted respectively. Results Data from 26 patients were investigated, five of whom required muscle relaxant to be restarted (i.e ‘failed clinical progression’ group). Within the 24 hours prior to stopping muscle relaxants, the ‘failed clinical progression group’ required significantly more interventions for raised ICP, low CPP, care procedures, tight CO2 or temperature control than the ‘successful clinical progression group’ (p < 0.05, Fisher’s Exact Test). Patients within ‘successful clinical progression group’ also demonstrated superior ability to maintain normal cerebral autoregulation pressure pattern prior to stopping muscle relaxant. Conclusions Requiring interventions 24 hours prior to stopping muscle relaxant may be a clinical indicator that a brain trauma patient is not ready for clinical progression. A larger study using routinely generated big-data and machine learning is underway through KidsBrainIT, a multi-centre multi-national EU grant funded initiative, to validate this finding.