Journal Article

Intracranial pressure complicating severe traumatic brain injury in children: monitoring and management

Forsyth, Robert J., Morris, Kevin P., Hawley, Carol A., Parslow, Roger C., Tasker, Robert C.

2006

Overview

To identify factors associated with the use of intracranial pressure (ICP) monitoring and to establish which ICP-targetted therapies are being used in children with severe traumatic brain injury (TBI) in the United Kingdom. To evaluate current practice against recently published guidelines. Prospective data collection of clinical and demographic information from paediatric and adult intensive care units in the UK and Ireland admitting children (< 16 years) with TBI between February 2001 and August 2003. Detailed clinical information was obtained for 501 children, with information on the use of ICP monitoring available in 445. ICP monitoring was used in only 59% (75/127) of children presenting with an emergency room Glasgow Coma Scale of 8 or below. Large between centre variation was seen in the use of ICP monitoring, independent of severity of injury. There were 86 children who received ICP-targetted therapies without ICP monitoring. Wide between centre variation was found in the use of ICP-targetted therapies and in general aspects of management, such as fluid restriction, the use of muscle relaxants and prophylactic anticonvulsants. Intra-ventricular catheters are rarely placed (6% of cases); therefore cerebrospinal fluid drainage is seldom used as a first-line therapy for raised ICP. Jugular venous bulb oximetry (4%), brain microdialysis (< 1%) and brain tissue oxygen monitoring (< 1%) are rarely used in current practice. Contrary to published guidelines, moderate to severe hyperventilation is being used without monitoring for cerebral ischaemia. There is an urgent need for greater standardisation of practice across UK centres admitting children with severe TBI.

• Publisher: Springer,Springer Nature B.V
• Subject: Adolescent / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Biological and medical sciences / Brain / Brain Injuries - complications / Brain Injuries - physiopathology / Brain Injuries - therapy / Brain research / Child / Child, Preschool / Children / Children & youth / Childrens health / Coma / Complications and side effects / Data collection / Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine / Epidemiology / Female / Health aspects / Hospitals / Humans / Hyperventilation / Infant / Infant, Newborn / Injuries / Injuries of the nervous system and the skull. Diseases due to physical agents / Intensive care / Intensive care medicine / Intensive Care Units, Pediatric - statistics & numerical data / Intracranial Hypertension - etiology / Intracranial Hypertension - physiopathology / Intracranial Hypertension - therapy / Intracranial Pressure / Logistic Models / Male / Medical sciences / Monitoring, Physiologic - methods / Pediatrics / Practice Guidelines as Topic / Proportional Hazards Models / Prospective Studies / Questionnaires / Research ethics / Traumas. Diseases due to physical agents / Traumatic brain injury / United Kingdom