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Updated: Jan 28, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Management of Pediatric Severe Traumatic Brain Injury: 2019 Consensus and Guidelines-Based Algorithm for First and
Patrick M Kochanek1, Robert C Tasker2,3, Michael J Bell4
1Department of Critical Care Medicine, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
Insights
This study developed a treatment algorithm for managing severe traumatic brain injury in pediatric patients. It offers a structured approach to reduce intracranial pressure and improve outcomes for children with brain injuries.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma management
- Clinical algorithm development
Background:
- Severe traumatic brain injury (TBI) is a significant cause of mortality and morbidity in children.
- Existing guidelines for pediatric TBI management require a structured clinical algorithm for bedside application.
- Effective management of pediatric severe TBI necessitates addressing intracranial hypertension and optimizing cerebral perfusion.
Purpose of the Study:
- To create a comprehensive treatment algorithm for the intensive care unit (ICU) management of pediatric severe traumatic brain injury.
- To provide a practical, evidence-based approach for clinicians caring for critically injured children.
- To guide interventions aimed at mitigating secondary brain injury and improving patient outcomes.
Main Methods:
- Development of a treatment algorithm based on the 2019 Guidelines for the Management of Pediatric Severe Traumatic Brain Injury.
- Inclusion of consensus-based recommendations where evidence was insufficient.
- Integration of selected treatment protocols and emergent management strategies for cerebral herniation.
Main Results:
- The algorithm outlines baseline care for all pediatric severe TBI patients.
- It details a tiered therapeutic approach focusing on intracranial hypertension, cerebral perfusion pressure, and brain tissue oxygenation.
- The algorithm includes advanced therapies such as decompressive craniectomy and barbiturate infusion for refractory cases.
Conclusions:
- The developed algorithm provides a logical, evidence-based framework for bedside management of pediatric severe TBI.
- It aims to standardize care, reduce intracranial hypertension, and optimize cerebral perfusion.
- Implementation of this algorithm is expected to improve clinical outcomes for children with severe TBI.
Objectives:
To produce a treatment algorithm for the ICU management of infants, children, and adolescents with severe traumatic brain injury.
Data Sources:
Studies included in the 2019 Guidelines for the Management of Pediatric Severe Traumatic Brain Injury (Glasgow Coma Scale score ≤ 8), consensus when evidence was insufficient to formulate a fully evidence-based approach, and selected protocols from included studies.
Data Synthesis:
Baseline care germane to all pediatric patients with severe traumatic brain injury along with two tiers of therapy were formulated. An approach to emergent management of the crisis scenario of cerebral herniation was also included. The first tier of therapy focuses on three therapeutic targets, namely preventing and/or treating intracranial hypertension, optimizing cerebral perfusion pressure, and optimizing partial pressure of brain tissue oxygen (when monitored). The second tier of therapy focuses on decompressive craniectomy surgery, barbiturate infusion, late application of hypothermia, induced hyperventilation, and hyperosmolar therapies.
Conclusions:
This article provides an algorithm of clinical practice for the bedside practitioner based on the available evidence, treatment protocols described in the articles included in the 2019 guidelines, and consensus that reflects a logical approach to mitigate intracranial hypertension, optimize cerebral perfusion, and improve outcomes in the setting of pediatric severe traumatic brain injury.
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