Neurocritical care and neuromonitoring considerations in acute pediatric spinal cord injury

Area of Science:

• Neurocritical Care
• Pediatric Neurology
• Spinal Cord Injury Management

Background:

• Pediatric spinal cord injury (SCI) management requires specialized neurocritical care expertise.
• Effective evaluation and characterization are vital for improving outcomes and prognostication in pediatric SCI.
• Current work-up relies on physical examination and imaging, with a need for advanced functional assessment tools.

Purpose of the Study:

• To provide a comprehensive review of pediatric SCI evaluation and management.
• To introduce a novel framework for monitoring pediatric SCI patients in the ICU.
• To highlight advancements in critical care techniques for SCI monitoring and management.

Main Methods:

• Review of current literature and critical care practices for pediatric SCI.
• Proposal of somatosensory evoked potentials (SSEPs) for functional evaluation of spinal cord tracts.
• Introduction of transcranial magnetic stimulation (TMS) for prognostication and rehabilitation response assessment.
• Discussion of spine stabilization, surgical decompression, and respiratory/hemodynamic management.

Main Results:

• SSEPs offer functional insights into dorsal column tracts crucial for hand function, ambulation, and bladder control.
• TMS shows potential in guiding prognostication and evaluating response to rehabilitation therapies.
• Emerging research indicates potential benefits from targeted spinal cerebral perfusion pressure management.

Conclusions:

• The review aims to enhance pediatric neurocritical care physicians' confidence in managing SCI.
• A novel algorithm for monitoring spinal cord function in the ICU is presented.
• Integration of advanced monitoring techniques like SSEPs and TMS can improve pediatric SCI care.