Association of Mean Arterial Pressure and Outcome in Children with Acute Non Traumatic Neurological Illnesses in Paediatric Intensive Care Unit: A Prospective Cohort Study

Abstract

Introduction: The course of outcome in non traumatic neurological illnesses, such as acute encephalitis syndrome, meningitis, paediatric stroke, metabolic encephalopathy, etc., can be affected by various risk factors. While there have been many studies evaluating the effects of blood pressure on outcomes in traumatic brain injury, there is a dearth of studies assessing Mean Arterial Pressure (MAP) in non traumatic injury, particularly in the paediatric age group. Aim: To examine the association between MAP and outcomes in children with acute non traumatic neurological illnesses in the Paediatric Intensive Care Unit (PICU), focusing on mortality and length of PICU stay. Materials and Methods: This prospective cohort study was conducted at Gandhi Medical College, Bhopal, Madhya Pradesh, India from September 2021 to August 2022. A total of 249 children aged between 1 to 14 years with acute non traumatic neurological illnesses were included, and their mean blood pressure was recorded. Associated co-morbidities (severe anaemia, respiratory failure, sepsis, and acute kidney injury), mean length of hospital stay, and outcome were also assessed. Categorical variables were analysed using either the Chi-squared (c2 ) test or Fisher’s exact test, while continuous variables were assessed using the Analysis of Variance (ANOVA) test for mean length of stay. Results: Out of the 249 subjects, 157 (63.1%) were male, and 143 (57.4%) belonged to the age group of 1-5 years. Among them, 36 (14.5%) experienced hypotension, and 17 (6.8%) had hypertension during their PICU stay, while 196 (78.7%) had normal blood pressure. Abnormal MAP was significantly associated with a higher mortality rate among the study subjects (p-value<0.001), and the mean length of PICU stay was significantly longer (p-value<0.001) in study subjects with abnormal MAP. Conclusion: Both high and low MAP were significantly associated with higher mortality and longer duration of stay in children with acute non traumatic neurological illnesses.