Clinical management and functional neuromonitoring in traumatic brain injury in children
Anne-Marie Guerguerian1, T Y Milly Lo, James S Hutchison
1Department of Critical Care Medicine, Neurosciences and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Severe traumatic brain injury in children requires advanced monitoring. Integrating biomarkers and neuromonitoring aids in assessing injury and treatment effectiveness for better outcomes.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Biomarker discovery
Background:
- Traumatic brain injury (TBI) is a leading cause of death and disability in children.
- Effective management of severe pediatric TBI is crucial for improving patient outcomes.
- Current monitoring strategies for pediatric TBI require enhancement.
Purpose of the Study:
- To review recent findings and emerging themes in severe pediatric TBI.
- To highlight the integration of neuromonitoring and biomarkers for TBI management.
- To propose enhanced clinical monitoring for critically ill children with TBI.
Main Methods:
- Review of published literature on severe pediatric TBI.
- Focus on lessons from a randomized clinical trial of hypothermia therapy.
- Discussion of bedside neuromonitoring techniques and biomarker integration.
Main Results:
- Neuromonitoring indices (e.g., pressure reactivity index, cerebral oximetry) assess cerebral autoregulation.
- Advanced techniques like electroencephalography and biomarker analysis evaluate coma and cellular pathways.
- Biomarkers can serve as surrogate endpoints and prognostic markers for TBI.
Conclusions:
- Expanding clinical functional neuromonitoring is recommended for pediatric TBI.
- Enhanced monitoring helps understand physiological variables and treatment responses.
- Improved management of critically ill children with TBI can be achieved through integrated monitoring.
Purpose Of Review:
Traumatic brain injury is the main cause of childhood disability and death. In this review, we highlight recent original findings and emerging themes from published literature on children with serious traumatic brain injury.
Recent Findings:
We focus this review on lessons learned from our recent randomized clinical trial of hypothermia therapy in severe traumatic brain injury in children and on bedside neuromonitoring. We propose that integrating the measurement of biomarkers into clinical care as surrogate endpoints and as potential prognostic markers would allow us to evaluate earlier the effect of injury and clinical care in children after traumatic brain injury. Several methods are now more readily available to monitor cerebral physiology in children. These methods include indices evaluating the integrity of cerebral autoregulation, such as the pressure reactivity index derived from values obtained from intracranial pressure measurements, flow velocity measurements from transcranial Doppler ultrasonography or from cerebral oximetry. Other methods allow the evaluation of coma with the nonlinear analysis of electroencephalography or the evaluation of cerebral metabolism and cell death pathways with biomarkers from serum, cerebral spinal fluid, and cerebral microdialysis.
Summary:
We suggest expanding clinical functional neuromonitoring to help clinicians understand the burden of exposure to physiological variables and response to therapies during intensive care in order to enhance the management of critically ill children with traumatic brain injury.
