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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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  • 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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