Current Guidelines for the Diagnosis and Treatment of Traumatic Brain Injury in Children
The article presents the basic diagnostic and therapeutic measures in traumatic brain injury in children, presented in the second edition of «Guidelines for the Acute Medical Management of Severe Traumatic Brain Injury in Infants, Children, and Adolescents», published in Pediatric Critical Care Medicine (2012, Vol. 13, № 1).
These guidelines include a number of sections: indications for intracranial pressure monitoring, intracranial pressure values, requiring treatment of intracranial hypertension, the magnitude of the perfusion pressure of the brain, the use of extended neuromonitoring, brain scans, hyperosmolar therapy, body temperature regulation, cerebrospinal fluid drainage, use of barbiturates, decompression craniectomy for treatment of intracranial hypertension, hyperventilation, use of corticosteroids, analgesics, sedatives and neuromuscular blockade, glucose and nutrition, prevention of seizures.
The guidelines include literary sources of II and III levels of evidence on basic issues of intensive care for traumatic brain injury in children. All this allowed us to select main points of diagnosis and intensive care of pediatric traumatic brain injury and formulate their features.
It is widely accepted that there are additional difficulties in assessing the severity of head injuries only on the basis of clinical manifestations in children as compared to adults. Moreover, the younger the child, the more difficulties usually exist in diagnosis. So, atypical course of intracranial injuries is distinctive for children. This can be manifested, on the one hand, by a long asymptomatic course in life-threatening injuries in a child, and on the other hand — by severe clinical manifestations even with minimal brain injury. This peculiarity of the course of head injuries in children can be explained by age anatomical and physiological characteristics.
The following guidelines must be included in the treatment algorithm of traumatic brain injuries in children of all pediatric intensive care units of Ukraine regardless of their level of accreditation, as this will allow to change and to improve qualitatively early used treatment measures, to reduce mortality in this group of children and to reduce significantly subsequent neurological deficit in them.
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Kochanek P.M., Carney N., Adelson P.D., Ashwal S., Bell M.J., Bratton S., Carson S., Chesnut R.M., Ghajar J., Goldstein B., Grant G.A., Kissoon N., Peterson K., Selden N.R., Tasker R.C., Tong K.A., Vavilala M.S., Wainwright M.S., Warden C.R.; American Academy of Pediatrics-Section on Neurological Surgery; American Association of Neurological Surgeons/Congress of Neurological Surgeons; Child Neurology Society; European Society. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents — second edition // Pediatr. Crit. Care Med. 2012 Jan;13 Suppl. 1: S1-82. doi: 10.1097/PCC.0b013e31823f435c.
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