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Pediatric traumatic brain injury: beyond the guidelines.
1Department of Critical Care Medicine, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA. kochanekpm@ccm.upmc.edu
Current Treatment Options in Neurology
|October 14, 2005
Summary
Guidelines for severe traumatic brain injury in children focus on managing intracranial hypertension. New developments include optimizing cerebral perfusion pressure and considering hypothermia or decompressive craniectomy.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma management
- Intensive care unit (ICU) protocols
Background:
- First guidelines for severe traumatic brain injury (TBI) in children were established in 2003.
- Initial management prioritizes preventing secondary insults like hypotension and hypoxemia.
- Intracranial hypertension is a primary therapeutic target in pediatric TBI.
Purpose of the Study:
- To review established and emerging therapies for managing intracranial hypertension in pediatric TBI patients.
- To discuss advancements in the critical pathway for TBI management.
- To highlight new developments in optimizing cerebral perfusion pressure (CPP).
Main Methods:
- Synopsis of the established critical pathway for TBI management.
- Review of first- and second-tier therapies for intracranial hypertension.
- Discussion of emerging therapeutic modalities.
Main Results:
- The critical pathway emphasizes limiting intracranial hypertension and optimizing CPP.
- Emerging evidence supports mild-moderate hypothermia as a therapeutic option.
- Decompressive craniectomy is also supported by emerging evidence.
Conclusions:
- Contemporary management of pediatric TBI centers on controlling intracranial pressure.
- A refined understanding of optimal CPP targets is crucial for therapy.
- Hypothermia and decompressive craniectomy represent significant advancements in TBI treatment.