Integrated Cerebral Autoregulation Score for Early Risk Stratification in Severe TBI

ICAS for Early Risk Stratification in PICU

Authors

DOI:

https://doi.org/10.70099/BJ/2026.03.02.3

Keywords:

pediatric traumatic brain injury, cerebral autoregulation, pressure reactivity index, cerebral perfusion pressure, pediatric neurocritical care

Abstract

Background: Impaired cerebral autoregulation is associated with worse outcomes in pediatric severe traumatic brain injury (TBI). We aimed to identify early predictors of autoregulatory failure and to develop a bedside risk stratification tool, the Pediatric Integrated Cerebral Autoregulation Score (pICAS).

 

Methods: We conducted a retrospective multicenter cohort study including 100 children (0–18 years) with severe TBI (Glasgow Coma Scale ≤8) who required vasopressor support within 72 hours of admission. Continuous multimodal neuromonitoring included intracranial pressure (ICP), cerebral perfusion pressure (CPP), optimal CPP (CPPopt), pressure reactivity index (PRx), brain tissue oxygenation (PbtO₂, when available), and mean arterial pressure (MAP) variability.

 

Results: Impaired autoregulation, defined as a mean PRx > 0.30, was observed in 49% of patients. Five early predictors, ICP ≥ 20 mmHg, PRx > 0.30 for more than 35% of monitoring time, MAP variability > 12 mmHg, CPP below CPPopt for more than 30% of time, and a norepinephrine-equivalent dose ≥ 0.1 µg/kg/min, were incorporated into pICAS (score range 0–5), enabling risk stratification from 10% to 90%.

 

Conclusions: pICAS allows rapid bedside risk stratification for impaired cerebral autoregulation in children with severe TBI and may support individualized perfusion management strategies.

References

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Published

2026-04-17

How to Cite

Carbonell Gonzalez, M., Santiago Roibal, R., Cabrera Rodríguez, D., & Ayala Pérez, J. L. (2026). Integrated Cerebral Autoregulation Score for Early Risk Stratification in Severe TBI: ICAS for Early Risk Stratification in PICU. BioNatura Journal: Ibero-American Journal of Biotechnology and Life Sciences. https://doi.org/10.70099/BJ/2026.03.02.3

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Copyright (c) 2026 Marlon Carbonell Gonzalez, Rosali Santiago Roibal, Deborah Cabrera Rodríguez, Jorge Luis Ayala Pérez (Author)

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