TY - JOUR
T1 - Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition
T2 - Update of the Brain Trauma Foundation Guidelines, Executive Summary
AU - Kochanek, Patrick M.
AU - Tasker, Robert C.
AU - Carney, Nancy
AU - Totten, Annette M.
AU - Adelson, P. David
AU - Selden, Nathan R.
AU - Davis-O'reilly, Cynthia
AU - Hart, Erica L.
AU - Bell, Michael J.
AU - Bratton, Susan L.
AU - Grant, Gerald A.
AU - Kissoon, Niranjan
AU - Reuter-Rice, Karin E.
AU - Vavilala, Monica S.
AU - Wainwright, Mark S.
N1 - Publisher Copyright:
Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Objectives: The purpose of this work is to identify and synthesize research produced since the second edition of these Guidelines was published and incorporate new results into revised evidence-based recommendations for the treatment of severe traumatic brain injury in pediatric patients. Methods and Main Results: This document provides an overview of our process, lists the new research added, and includes the revised recommendations. Recommendations are only provided when there is supporting evidence. This update includes 22 recommendations, nine are new or revised from previous editions. New recommendations on neuroimaging, hyperosmolar therapy, analgesics and sedatives, seizure prophylaxis, temperature control/hypothermia, and nutrition are provided. None are level I, three are level II, and 19 are level III. The Clinical Investigators responsible for these Guidelines also created a companion algorithm that supplements the recommendations with expert consensus where evidence is not available and organizes possible interventions into first and second tier utilization. The purpose of publishing the algorithm as a separate document is to provide guidance for clinicians while maintaining a clear distinction between what is evidence based and what is consensus based. This approach allows, and is intended to encourage, continued creativity in treatment and research where evidence is lacking. Additionally, it allows for the use of the evidence-based recommendations as the foundation for other pathways, protocols, or algorithms specific to different organizations or environments. The complete guideline document and supplemental appendices are available electronically from this journal. These documents contain summaries and evaluations of all the studies considered, including those from prior editions, and more detailed information on our methodology. Conclusions: New level II and level III evidence-based recommendations and an algorithm provide additional guidance for the development of local protocols to treat pediatric patients with severe traumatic brain injury. Our intention is to identify and institute a sustainable process to update these Guidelines as new evidence becomes available.
AB - Objectives: The purpose of this work is to identify and synthesize research produced since the second edition of these Guidelines was published and incorporate new results into revised evidence-based recommendations for the treatment of severe traumatic brain injury in pediatric patients. Methods and Main Results: This document provides an overview of our process, lists the new research added, and includes the revised recommendations. Recommendations are only provided when there is supporting evidence. This update includes 22 recommendations, nine are new or revised from previous editions. New recommendations on neuroimaging, hyperosmolar therapy, analgesics and sedatives, seizure prophylaxis, temperature control/hypothermia, and nutrition are provided. None are level I, three are level II, and 19 are level III. The Clinical Investigators responsible for these Guidelines also created a companion algorithm that supplements the recommendations with expert consensus where evidence is not available and organizes possible interventions into first and second tier utilization. The purpose of publishing the algorithm as a separate document is to provide guidance for clinicians while maintaining a clear distinction between what is evidence based and what is consensus based. This approach allows, and is intended to encourage, continued creativity in treatment and research where evidence is lacking. Additionally, it allows for the use of the evidence-based recommendations as the foundation for other pathways, protocols, or algorithms specific to different organizations or environments. The complete guideline document and supplemental appendices are available electronically from this journal. These documents contain summaries and evaluations of all the studies considered, including those from prior editions, and more detailed information on our methodology. Conclusions: New level II and level III evidence-based recommendations and an algorithm provide additional guidance for the development of local protocols to treat pediatric patients with severe traumatic brain injury. Our intention is to identify and institute a sustainable process to update these Guidelines as new evidence becomes available.
KW - critical care
KW - evidence-based medicine
KW - guidelines
KW - pediatrics
KW - systematic review
KW - traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85062416435&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85062416435&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000001736
DO - 10.1097/PCC.0000000000001736
M3 - Article
C2 - 30830016
AN - SCOPUS:85062416435
SN - 1529-7535
VL - 20
SP - 280
EP - 289
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 3
ER -