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Intracranial pressure complicating severe traumatic brain injury in children: monitoring and management
Published in:
Intensive Care Med, Vol: 32, Page: 1606-12
Publication Date:
October 2006
Aims & Objectives:
The aim of this study was to examine the use of intracranial pressure monitoring and to establish which ICP-targeted therapies are being used in children with severe traumatic brain injury in the United Kingdom
Abstract:
OBJECTIVE: 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. DESIGN AND SETTING: 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. RESULTS: 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. CONCLUSIONS: There is an urgent need for greater standardisation of practice across UK centres admitting children with severe TBI.
Authors:
Study Type:
Study Papers » Case Study » Descriptive Studies - Without a comparision
Notes:
UK Paediatric Traumatic Brain Injury Study Group Paediatric Intensive Care Society Study Group
Categories:
severe traumatic brain injury
International Classification:
Injury, poisoning and certain other consequences of external causes - injury
Keywords:
- Adolescent
- Brain Injuries/ complications/physiopathology/ therapy
- Child
- Child, Preschool
- Female
- Great Britain
- Humans
- Infant
- Infant, Newborn
- Intensive Care Units, Pediatric/statistics & numerical data
- Intracranial Hypertension/ etiology/physiopathology/ therapy
- Intracranial Pressure
- Logistic Models
- Male
- Monitoring, Physiologic/ methods
- Practice Guidelines as Topic
- Proportional Hazards Models
- Prospective Studies
Geography:
Republic of Ireland and the United Kingdom (UK and Republic of Ireland)