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12 - Intensive Care Unit Management of Pediatric Brain Injury

Published online by Cambridge University Press:  18 January 2010

By
Robert Cohn ,
Maroun J. Mhanna ,
Elie Rizkala  and
Dennis M. Super
Edited by
Charles E. Smith
Robert Cohn
Affiliation:
Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Maroun J. Mhanna
Affiliation:
Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Elie Rizkala
Affiliation:
Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Dennis M. Super
Affiliation:
Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Charles E. Smith
Affiliation:
Case Western Reserve University, Ohio
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Summary

Objectives

  1. State the significance and incidence of traumatic brain injury in children as well as the impact of preventive care.

  2. Recognize when a child with a closed-head injury is developing increased intracranial hypertension.

  3. Describe the pathophysiology of primary brain injury as well as the process leading to the secondary injury.

  4. List therapies (as well as the rationale) for both the first-tier and second-tier therapies for the management of severe traumatic brain injury in children.

SUMMARY

Severe traumatic brain injury (TBI) is a leading cause of mortality and morbidity in children. The epidemiology, pathophysiology, and rational for various treatment modalities are presented in this chapter. In addition, clinical guidelines are reported in an algorithm format to aide the clinician caring for the critically ill children.

INTRODUCTION AND CLINICAL PRESENTATIONS

Although most TBIs in children are minor, head injury is the leading cause of pediatric death from trauma and it is the leading cause of acquired disability annually. By some accounts TBI results in 400,000 emergency department visits per year. Three to fifteen percent of cases result in moderate to severe TBI, and 9 to 50 percent of the most severe cases result in death. With current management approaches, mortality is only half that reported in adults presenting with similar Glasgow Coma Scores (GCS) [1–5]. Survival, however, has been associated with subsequent cognitive and behavioral impairment.

Prognosis and mechanisms of injury vary by age, type of activity, geographical location, and helmet use.

Type
Chapter
Information
Trauma Anesthesia , pp. 187 - 201
Publisher: Cambridge University Press
Print publication year: 2008

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References

Fackler JC, Yaster M, Davis RJ, Tait VF, Dean JM, Goldberg AL, Rogers MC. Multiple trauma and spinal cord injury in the pediatric patient. In Rogers, MC, Helfner, MA, eds. Handbook of Pediatric Intensive Care, 2nd edition. Baltimore: Williams and Wilkins, 1995, pp 717–44.Google Scholar
Thiessen, ML, Woolridge, DP. Pediatric minor closed head injury. Pediatric emergencies, Part I. Pediatr Clin N Am 2006;53(1):1–26.CrossRefGoogle Scholar
Slomine, BS, McCarthy, ML, Ding, R, et al. Health care utilization and needs after pediatric traumatic brain injury. Pediatrics 2006;117(4):663–74.CrossRefGoogle ScholarPubMed
Kehle TJ, Clark E, Jenson WR. Interventions for students with traumatic brain injury: managing behavioral disturbances. In Bigler, ED, Clark, E, Farmer, JE, eds. Childhood Traumatic Brain Injury. Austin, TX: Pro-Ed, 1997, pp 135–51.Google Scholar
Ghajar, J, Hariri, RJ. Management of pediatric head injury. Pediatr Clin N Am 1992;39(5):1093–125.CrossRefGoogle ScholarPubMed
Aryan, HE, Ghosheh, FR, Jandial, R, Levy, ML. Retinal hemorrhage and pediatric brain injury: Etiology and review of the literature. J Clin Neurosci 2005;12(6):624–31.CrossRefGoogle ScholarPubMed
Bayir, H, Kochanek, PM, Clark, RS. Traumatic brain injury in infants and children: Mechanisms of secondary damage and treatment in the intensive care unit (Review). Crit Care Clin 2003;19(3):529–49.CrossRefGoogle Scholar
Harukuni, I, Bhardwaj, A. Mechanisms of brain injury after global cerebral ischemia (Review). Neurol Clin 2006;24(1):1–21.CrossRefGoogle Scholar
Okonkwo, , Stone, JR. Basic science of closed head injuries and spinal cord injuries (Review). Clin Sports Med. 2003;22(3):467–81.CrossRefGoogle Scholar
Schutzman, SA, Barnes, P, Duhaime, AC, Greenes, D, Homer, C, Jaffe, D, et al. Evaluation and management of children young than two years old with apparently minor head trauma: Proposed guidelines (Review). Pediatrics 2001;107(5):983–93.CrossRefGoogle Scholar
Bruce, DA, Schut, L, Bruno, , Wood, JH, Sutton, LN. Outcome following severe head injuries in children. J Neurosurg 1978;48(5):679–88.CrossRefGoogle ScholarPubMed
Strich, SJ. Lesions in the cerebral hemispheres after blunt head injury. J Clin Pathol Suppl (R Coll Pathol) 1970;4:166–71.CrossRefGoogle ScholarPubMed
James, HE. Pediatric head injury: What is unique and different?Acta Neurchir (Wien) 1999;739:85–88Google Scholar
Koehler, RC, Gebremedhin, D, Harder, DR. Regulation of the cerebral circulation: Role of astrocyles in cerebrovascular regulation. J Appl Physiol 2006;100:307–17.CrossRefGoogle ScholarPubMed
Anderson, J, Shofi, NI, Bryan, RM. Regulation of the cerebral circulation: Endothelial influences on cerebrovascular tone. J Appl Physiol 2006;100:318–27.CrossRefGoogle Scholar
Armstead, WM. Role of nitric oxide, cyclic nucleotides, and the activation of ATP-sensitive K+ channels in the contribution of adenosine to hypoxia-induced pial artery dilation. J Cereb Blood Flow Metab 1997;17(1):100–08.CrossRefGoogle ScholarPubMed
Vavilala, MS, Lee, , Boddu, K, Visco, E, Newell, DW, Zimmerman, JJ, et al. Cerebral autoregulation in pediatric traumatic brain injury. Pediatr Crit Care Med 2004;5(3):257–63.CrossRefGoogle ScholarPubMed
Marmarou, A, Signoretti, S, Fatouros, PP, Portella, G, Aygok, GA, et al. Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries. J Neurosurg 2006;104(5):720–30.CrossRefGoogle ScholarPubMed
Kimelberg, HK. Astrocytic swelling in cerebral ischemia as a possible cause of injury and target for therapy (Review). Glia 2005;50(4):389–97.CrossRefGoogle Scholar
Faden, AI, Demediuk, P, Panter, SS, Vink, R. The role of excitatory amino acids and NMDA receptors in traumatic brain injury. Science 1989;244(4906):798–800.CrossRefGoogle ScholarPubMed
Tymianski, M, Tator, CH. Normal and abnormal calcium homeostatis in neurons: A basis for the pathophysiology of traumatic and ischemic central nervous system injury (Review). Neurosurgery 1996;38(6):1176–95.Google Scholar
Ruppel, RA, Kochanek, PM, Adelson, PD, Rose, ME, Wisniewski, SR, Bell, MJ, Clark, RS, Marion, DW, Graham, SH. Excitatory amino acid concentrations in ventricular cerebrospinal fluid after severe traumatic brain injury in infants and children: The role of child abuse. J Pediatr 2001;138(1):18–25.CrossRefGoogle ScholarPubMed
Arundine, M, Aarts, M, Lau, A, Tymianski, M. Vulnerability of central neurons to secondary insults after in vitro mechanical stretch. J Neurosci 2004;24(37):8106–23.CrossRefGoogle ScholarPubMed
Marshall, LF, Maas, AI, Marshall, SB, Bricolo, A, Fearnside, M, Iannotti, F, et al. Multicenter trial on the efficacy of using tirilazad mesylate in cases of head injury. J Neurosurg 1998;89(4):519–25.CrossRefGoogle ScholarPubMed
Morris, GF, Juul, N, Marshall, SB, Benedict, B, Marshall, LF. Neurological deterioration as a potential alternative endpoint in human clinical trials of experimental pharmacological agents for treatment of severe traumatic brain injuries. Executive Committee of the International Selfotel Trial. Neurosurgery 1998;43(6):1369–72; discussion 1372–4.Google Scholar
Danton, GH, Dietrich, WD. Inflammatory mechanisms after ischemia and stroke (Review). J Neuropathol Exp Neurol 2003;62(2):127–36.CrossRefGoogle Scholar
Marklund, N, Bakshi, A, Castelbuono, DJ, Conte, V, McIntosh, TK. Evaluation of pharmacological treatment strategies in traumatic brain injury (Review). Curr Pharm Des 2006;12(13):1645–80.CrossRefGoogle Scholar
Kerr, JF. History of the events leading to the formulation of the apoptosis concept (Review). Toxicology 2002;27:181–82, 471–4.Google Scholar
Serbest, G, Horwitz, J, Jost, M, Barbee, K. Cell death and neuroprotection by poloxamer 188 after mechanical trauma. FASEB J 2006;20(2):308–10. Epub December 21, 2005.CrossRefGoogle ScholarPubMed
Adelson, PD. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Crit Care Med 2003;31(6 Suppl):S417–91.Google Scholar
Adelson, PD. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 5. Indications for intracranial pressure monitoring in pediatric patients with severe traumatic brain injury. Pediatr Crit Care Med 2003;4(3 Suppl):S19–24.Google ScholarPubMed
Adelson, PDGuidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. Pediatr Crit Care Med 2003;4(3 Suppl):S25–7.Google ScholarPubMed
Adelson, PD. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 8. Cerebral perfusion pressure. Pediatr Crit Care Med 2003;4(3 Suppl):S31–3.Google Scholar
Adelson, PD. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 7. Intracranial pressure monitoring technology. Pediatr Crit Care Med 2003;4(3 Suppl):S28–30.Google ScholarPubMed
Narotam, PK, Burjonrappa, SC, Raynor, SC, Rao, M, Taylon, C. Cerebral oxygenation in major pediatric trauma: Its relevance to trauma severity and outcome. J Pediatr Surg 2006;41(3):505–13.CrossRefGoogle ScholarPubMed
Nilsson B, Rehncrona S, Siesjo BK. Coupling of cerebral metabolism and blood flow in epileptic seizures, hypoxia and hypoglycemia. In Purves, M, ed. Cerebral Vascular Smooth Muscle and Its Control. Amsterdam: Excerpta Medica, Elsevier, 1978, pp 199–218.Google Scholar
Rehncrona S, Siesjo BK. Metabolic and physiologic changes in acute brain failure. In Grenvik, A, Safar, P, eds. Brain Failure and Resuscitation. New York: Churchill Livingstone, 1981, pp 11–33.Google Scholar
White, PF, Schlobohm, RM, Pitts, LH, et al. A randomized study of drugs for preventing increases in intracranial pressure during endotracheal suctioning. Anesthesiology 1982;57:242–4.CrossRefGoogle ScholarPubMed
Raju, TNK, Vidyasagar, D, Torres, C, et al. Intracranial pressure during intubation and anesthesia in infants. J Pediatr 1980;96:860–2.CrossRefGoogle Scholar
Kerr, ME, Weber, BB, Sereika, SM, et al. Effect of endotracheal suctioning on cerebral oxygenation in traumatic brain-injured patients. Crit Care Med 1999;27:2776–81.CrossRefGoogle ScholarPubMed
Adelson, PD. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 9. Use of sedation and neuromuscular blockade in the treatment of severe pediatric traumatic brain injury. Pediatr Crit Care Med 2003;4(3 Suppl):S34–7.Google Scholar
Prielipp, RC, Coursin, DB. Sedative and neuromuscular blocking drug use in critically ill patients with head injuries. New Horiz 1995;3:456–68.Google ScholarPubMed
Tobias, JD. Increased intracranial pressure after fentanyl administration in a child with closed head trauma. Pediatr Emerg Care 1994;10:89–90.CrossRefGoogle Scholar
Albanese, J, Durbec, O, Viviand, X, et al. Sufentanil increases intracranial pressure in patients with head trauma. Anesthesiology 1993;79:493–7.CrossRefGoogle ScholarPubMed
Cotev, S, Shalit, MN. Effects of diazepam on cerebral blood flow and oxygen uptake after head injury. Anesthesiology 1975;43:117–22.Google ScholarPubMed
Papazian, L, Albanese, J, Thirion, X, Perrin, G, Durbec, O, Martin, C. Effect of bolus doses of midazolam on intracranial pressure and cerebral perfusion pressure in patients with severe head injury. Br J Anaesth. 1993;71(2):267–71.CrossRefGoogle ScholarPubMed
Spitzfaden, AC, Jimenez, DF, Tobias, JD. Propofol for sedation and control of intracranial pressure in children. Pediatr Neurosurg 1999;31:194–200.PubMed
Farling, PA, Johnston, JR, Coppel, DL. Propofol infusion for sedation of patients with head injury in intensive care. Anaesthesia 1989;44:222–6.CrossRefGoogle ScholarPubMed
Steiner, , Johnston, AJ, Chatfield, DA, Czosnyka, M, Coleman, MR, Coles, JP, Gupta, AK, Pickard, JD, Menon, DK. The effects of large-dose propofol on cerebrovascular pressure autoregulation in head-injured patients. Anesth Analg. 2003;97(2):572–6.CrossRefGoogle ScholarPubMed
Bray, RJ. Propofol infusion syndrome in children. Paediatr Anaesth 1998;8:491–9.CrossRefGoogle ScholarPubMed
Hanna, JP, Ramundo, ML. Rhabdomyolysis and hypoxia associated with prolonged propofol infusion in children. Neurology 1998;50:301–3.CrossRefGoogle ScholarPubMed
Cray, SH, Robinson, BH, Cox, PN. Lactic acidemia and bradyarrhythmia in a child sedated with propofol. Crit Care Med 1998;26:2087–92.CrossRefGoogle Scholar
Parke, TJ, Stevens, JE, Rice, AS, et al. Metabolic acidosis and fatal myocardial failure after propofol infusion in children: Five case reports. BMJ 1992;305:613–6.Google ScholarPubMed
Canivet, JL, Gustad, K, Leclercq, P, et al. Massive ketonuria during sedation with propofol in a 12 year old girl with severe head trauma. Acta Anaesthesiol Belg 1994;45:19–22.Google Scholar
Hsiang, JK, Chesnut, RM, Crisp, CB, et al. Early, routine paralysis for intracranial pressure control in severe head injury: Is it necessary?Crit Care Med 1994;22:1471–6.CrossRefGoogle ScholarPubMed
Vernon, DD, Witte, MK. Effect of neuromuscular blockade on oxygen consumption and energy expenditure in sedated, mechanically ventilated children. Crit Care Med 2000;28:1569–71.CrossRefGoogle ScholarPubMed
Durbin, CG. Neuromuscular blocking agents and sedative drugs. Clinical uses and toxic effects in the critical care unit. Crit Care Clin 1981;7:480–506.Google Scholar
Martin, LD, Bratton, SL, Quint, P, et al. Prospective documentation of sedative, analgesic, and neuromuscular blocking agent use in infants and children in the intensive care unit: A multicenter perspective. Pediatr Crit Care Med 2001;2:205–10.CrossRefGoogle ScholarPubMed
Douglass, JA, Tuxen, DV, Horne, M, et al. Myopathy in severe asthma. Am Rev Respir Dis 1992;146:517–9.CrossRefGoogle ScholarPubMed
Levin, AB, Duff, TA, Javid, MJ. Treatment of increased intracranial pressure: A comparison of different hyperosmotic agents and the use of thiopental. Neurosurgery 1979;5:570–5.CrossRefGoogle ScholarPubMed
Muizelaar, JP, Lutz, HA, Becker, DP. Effect of mannitol on ICP and CBF and correlation with pressure autoregulation in severely head injured patients. J Neurosurg 1984;61:700–6.CrossRefGoogle ScholarPubMed
Muizelaar, JP, Wei, EP, Kontos, HA, et al. Mannitol causes compensatory vasoconstriction and vasodilation in response to blood viscosity changes. J Neurosurg 1983;59:822–8.CrossRefGoogle ScholarPubMed
Muizelaar, JP, Wei, EP, Kontos, HA, et al. Cerebral blood flow is regulated by changes in blood pressure and in blood viscosity alike. Stroke 1986;17:44–8.CrossRefGoogle ScholarPubMed
Raphaely, RC, Swedlow, DB, Downes, JJ, et al. Management of severe pediatric head trauma. Pediatr Clin N Am 1980;27:715–27.CrossRefGoogle ScholarPubMed
Bruce, DA, Alavi, A, Bilaniuk, L, et al. Diffuse cerebral swelling following head injuries in children: The syndrome of “malignant brain edema.”J Neurosurg 1981;54:170–8.CrossRefGoogle ScholarPubMed
Bouma, GJ, Muizelaar, JP. Cerebral blood flow, cerebral blood volume, and cerebrovascular reactivity after severe head injury. J Neurotrauma 1992;9:S333–48.Google ScholarPubMed
James, HE. Methodology for the control of intracranial pressure with hypertonic mannitol. Acta Neurochir 1980;51:161–72.CrossRefGoogle ScholarPubMed
Qureshi, AI, Suarez, JI. Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Crit Care Med 2000;28:3301–13.CrossRefGoogle ScholarPubMed
Khanna, S, Davis, D, Peterson, B, Fisher, B, Tung, H, O'Quigley, J, Deutsch, R. Use of hypertonic saline in the treatment of severe refractory posttraumatic intracranial hypertension in pediatric traumatic brain injury. Crit Care Med. 2000;28(4):1144–51.CrossRefGoogle ScholarPubMed
Adelson, PD. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 11. Use of hyperosmolar therapy in the management of severe pediatric traumatic brain injury. Pediatr Crit Care Med 2003;4(3 Suppl):S40–4.Google ScholarPubMed
Roberts, I, Yates, D, Sandercock, P, Farrell, B, Wasserberg, J, Lomas, G, Cottingham, R, Svoboda, P, Brayley, N, Mazairac, G, Laloe, V, Munoz-Sanchez, A, Arango, M, Hartzenberg, B, Khamis, H, Yutthakasemsunt, S, Komolafe, E, Olldashi, F, Yadav, Y, Murillo-Cabezas, F, Shakur, H, Edwards, P; CRASH trial collaborators. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): Randomised placebo-controlled trial. Lancet 2004;364(9442):1321–8.Google ScholarPubMed
EdwardsArango, P M, Balica, L, Cottingham, R, El-Sayed, H, Farrell, B, Fernandes, J, Gogichaisvili, T, Golden, N, Hartzenberg, B, Husain, M, Ulloa, MI, Jerbi, Z, Khamis, H, Komolafe, E, Laloe, V, Lomas, G, Ludwig, S, Mazairac, G, Munoz, Sanchez Mde L, Nasi, L, Olldashi, F, Plunkett, P, Roberts, I, Sandercock, P, Shakur, H, Soler, C, Stocker, R, Svoboda, P, Trenkler, S, Venkataramana, NK, Wasserberg, J, Yates, D, Yutthakasemsunt, S; CRASH trial collaborators. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. Lancet 2005;365(9475):1957–9.Google ScholarPubMed
Marion, DW, Darby, J, Yonas, H. Acute regional cerebral blood flow changes caused by severe head injuries. J Neurosurg 1991;74:407–14.CrossRefGoogle ScholarPubMed
Marion, DW. Does hyperventilation cause secondary brain injury?Crit Care Med 2006;34(4):1284–5.CrossRefGoogle ScholarPubMed
Stringer, WA, Hasso, AN, Thompson, JR, et al. Hyperventilation-induced cerebral ischemia in patients with acute brain lesions: Demonstration by Xenon-enhanced CT. Am J Neuroradiol 1993;14:475–84Google ScholarPubMed
Skippen, P, Seear, M, Poskitt, K, et al. Effect of hyperventilation on regional cerebral blood flow in head-injured children. Crit Care Med 1997;25:1402–9.CrossRefGoogle ScholarPubMed
Adelson, PDGuidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 12. Use of hyperventilation in the acute management of severe pediatric traumatic brain injury. Pediatr Crit Care Med 2003;4(3 Suppl):S45–8.Google ScholarPubMed
Ginsberg, MD, Busto, R. Combating hyperthermia in acute stroke: A significant clinical concern. Stroke 1998;29(2):529–34.CrossRefGoogle ScholarPubMed
Busto, R, Dietrich, WD, Globus, MYT, Valdes, I, Scheinberg, P, Ginsberg, MD. Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury. J Cereb Blood Flow Metab 1987;7:729–38.CrossRefGoogle ScholarPubMed
Marion, DW, White, MJ. Treatment of experimental brain injury with moderate hypothermia and 21-aminosteroids. J Neurotrauma 1996;13:139–47.CrossRefGoogle ScholarPubMed
Pomeranz, S, Safar, P, Radovsky, A, Tisherman, SA, Alexander, H, Stezoski, W. The effect of resuscitative moderate hypothermia following epidural brain compression on cerebral damage in a canine outcome model. J Neurosurg 1993;79:241–51CrossRefGoogle Scholar
Smith, SL, Hall, ED. Mild pre- and posttraumatic hypothermia attenuates blood-brain barrier damage following controlled cortical impact injury in the rat. J Neurotrauma 1996;13:1–9.CrossRefGoogle ScholarPubMed
Clasen, RA, Pandolfi, S, Russell, J, Stuart, D, Hass, GM. Hypothermia and hypotension in experimental cerebral edema. Arch Neurol 1968;19:472–86.CrossRefGoogle ScholarPubMed
Marion, DW, Penrod, , Kelsey, SF, Obrist, WD, Kochanek, PM, Palmer, AM, Wisniewski, SR, DeKosky, ST. treatment of traumatic brain injury with moderate hypothermia. N Engl J Med 1997;336:540–546.CrossRefGoogle ScholarPubMed
Clifton, GL, Miller, ER, Choi, SC, Levin, HS, McCauley, S, Smith, KR Jr, Muizelaar, JP, Wagner, FC Jr, Marion, DW, Luerssen, TG, Chesnut, RM, Schwartz, M. Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med. 2001;344(8):556–63.CrossRefGoogle ScholarPubMed
Biswas, AK, Bruce, DA, Sklar, FH, Bokovoy, JL, Sommerauer, JF. Treatment of acute traumatic brain injury in children with moderate hypothermia improves intracranial hypertension. Crit Care Med 2002;30(12):2742–51.CrossRefGoogle ScholarPubMed
Adelson, PD, Ragheb, J, Kanev, P, Brockmeyer, D, Beers, SR, Brown, SD, Cassidy, LD, Chang, Y, Levin, H. Phase II clinical trial of moderate hypothermia after severe traumatic brain injury in children. Neurosurgery 2005;56(4):740–54.CrossRefGoogle ScholarPubMed
Stiefel, MF, Heuer, GG, Smith, MJ, Bloom, S, Maloney-Wilensky, E, Gracias, VH, Grady, MS, LeRoux, PD. Cerebral oxygenation following decompressive hemicraniectomy for the treatment of refractory intracranial hypertension. J Neurosurg 2004;101(2):241–7.CrossRefGoogle ScholarPubMed
Bor-Seng-Shu, E, Hirsch, R, Teixeira, MJ, Andrade, AF, Marino, R Jr. Cerebral hemodynamic changes gauged by transcranial Doppler ultrasonography in patients with posttraumatic brain swelling treated by surgical decompression. J Neurosurg 2006;104(1):93–100.CrossRefGoogle ScholarPubMed
Polin, RS, Shaffrey, ME, Bogaev, CA, Tisdale, N, Germanson, T, Bocchicchio, B, Jane, JA. Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery 1997;41(1):84–92.CrossRefGoogle ScholarPubMed
Taylor, A, Butt, W, Rosenfeld, J, Shann, F, Ditchfield, M, Lewis, E, Klug, G, Wallace, D, Henning, R, Tibballs, J. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 2001;17(3):154–62.CrossRefGoogle ScholarPubMed
Cho, DY, Wang, YC, Chi, CS. Decompressive craniotomy for acute shaken/impact baby syndrome. Pediatr Neurosurg 1995;23(4):192–8.CrossRefGoogle ScholarPubMed
Adelson, PD. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 16. The use of corticosteroids in the treatment of severe pediatric traumatic brain injury. Pediatr Crit Care Med. 2003;4(3 Suppl):S60–4.Google ScholarPubMed
Roberts, I. Barbiturates for acute traumatic brain injury. Cochrane Database Syst Rev 2000;(2):CD000033.Google ScholarPubMed
Eisenberg, HM, Frankowski, RF, Contant, CF, et al. High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg 1988;69:15–23.CrossRefGoogle ScholarPubMed
Kasoff, SS, Lansen, TA, Holder, D, et al. Aggressive physiologic monitoring of pediatric trauma patients with elevated intracranial pressure. Pediatr Neurosci 1988;14:241–9.CrossRefGoogle ScholarPubMed
Cormio, M, Gopinath, SP, Valadka, A, Robertson, CS. Cerebral hemodynamic effects of pentobarbital coma in head-injured patients. J Neurotrauma 1999;16(10):927–36.CrossRefGoogle ScholarPubMed
Schierhout, G, Roberts, I. Anti-epileptic drugs for preventing seizures following acute traumatic brain injury. Cochrane Database Syst Rev 2001;(4):CD000173.CrossRefGoogle ScholarPubMed
Tilford, JM, Simpson, PM, Yeh, TS, et al. Variation in therapy and outcome for pediatric head trauma patients. Crit Care Med 2001;29:1056–61.CrossRefGoogle ScholarPubMed
Young, KD, Okada, PJ, Sokolove, PE, Palchak, MJ, Panacek, EA, Baren, JM, Huff, KR, McBride, DQ, Inkelis, SH, Lewis, RJ. A randomized, double-blinded, placebo-controlled trial of phenytoin for the prevention of early posttraumatic seizures in children with moderate to severe blunt head injury. Ann Emerg Med 2004;43(4):435–46.CrossRefGoogle Scholar
Ng, I, Lim, J, Wong, HB. Effects of head posture on cerebral hemodynamics: Its influences on intracranial pressure, cerebral perfusion pressure, and cerebral oxygenation. Neurosurgery 2004;54(3):593–7.CrossRefGoogle ScholarPubMed
Feldman, Z, Kanter, MJ, Robertson, CS, Contant, CF, Hayes, C, Sheinberg, MA, Villareal, CA, Narayan, RK, Grossman, RG. Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients. J Neurosurg 1992;76(2):207–11.CrossRefGoogle ScholarPubMed
Adelson, PDGuidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 17. Critical pathway for the treatment of established intracranial hypertension in pediatric traumatic brain injury. Pediatr Crit Care Med 2003;4(3 Suppl):S65–7.Google Scholar
Taketomo, CK, Hodding, JH, Kraus, DM. Lexi-Comp's Pediatric Dosage Handbook, 10th Edition. 2003–2004.

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  • Intensive Care Unit Management of Pediatric Brain Injury
    • By Robert Cohn, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Maroun J. Mhanna, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Elie Rizkala, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Dennis M. Super, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.015
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  • Intensive Care Unit Management of Pediatric Brain Injury
    • By Robert Cohn, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Maroun J. Mhanna, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Elie Rizkala, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Dennis M. Super, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.015
Available formats
×

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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Intensive Care Unit Management of Pediatric Brain Injury
    • By Robert Cohn, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Maroun J. Mhanna, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Elie Rizkala, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Dennis M. Super, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.015
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