TY - JOUR
T1 - Management of Pediatric Severe Traumatic Brain Injury
T2 - 2019 Consensus and Guidelines-Based Algorithm for First and Second Tier Therapies
AU - Kochanek, Patrick M.
AU - Tasker, Robert C.
AU - Bell, Michael J.
AU - Adelson, P. David
AU - Carney, Nancy
AU - Vavilala, Monica S.
AU - Selden, Nathan R.
AU - Bratton, Susan L.
AU - Grant, Gerald A.
AU - Kissoon, Niranjan
AU - Reuter-Rice, Karin E.
AU - Wainwright, Mark S.
N1 - Funding Information:
Dr. Kochanek received funding from the Society of Critical Care Medicine (Editor-in-Chief of Pediatric Critical Care Medicine) and from serving as an expert witness on cases in pediatric critical care. Dr. Selden disclosed that he has stock options (current $0 value) in Cerebrotech for scientific advisory board service (this device is not clinically available and is not referenced in the work). Dr. Reuter-Rice received funding from textbook royalties and Robert Wood Johnson Foundation funding 2013–2016. Dr. Wainwright received funding from Sage Therapeutics. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: kochanekpm@ccm.upmc.edu
Funding Information:
This algorithm is not intended to supplant physician judgment with respect to particular patients or special clinical situations and are not a substitute for physician-patient consultation. Accordingly, the Brain Trauma Foundation, American Association of Neurologic Surgeons, and Congress of Neurologic Surgeons consider adherence application of this algorithm to be voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient’s individual circumstances. Drs. Kochanek and Tasker contributed equally to the article. Supported, in part, by the U.S. Army Contracting Command, Aberdeen Proving Ground, Natick Contracting Division, through a contract awarded to Stanford University (W911 QY-14-C-0086), a subcontract awarded to Oregon Health & Science University. Prior editions were supported, in part, by funding from multiple sources through the Brain Trauma Foundation.
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: 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.
AB - 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.
KW - barbiturate
KW - decompressive craniectomy
KW - head injury
KW - herniation
KW - hyperosmolar
KW - intracranial pressure
UR - http://www.scopus.com/inward/record.url?scp=85062414958&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85062414958&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000001737
DO - 10.1097/PCC.0000000000001737
M3 - Article
C2 - 30830015
AN - SCOPUS:85062414958
VL - 20
SP - 269
EP - 279
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
SN - 1529-7535
IS - 3
ER -