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

Lookup NU author(s): Dr Rob Forsyth

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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. Intraventricular 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.


Publication metadata

Author(s): Morris KP, Forsyth RJ, Parslow RC, Tasker RC, Hawley CA

Publication type: Article

Publication status: Published

Journal: Intensive Care Medicine

Year: 2006

Volume: 32

Issue: 10

Pages: 1606-1612

ISSN (print): 0342-4642

ISSN (electronic): 1432-1238

Publisher: Springer

URL: http://dx.doi.org/10.1007/s00134-006-0285-4

DOI: 10.1007/s00134-006-0285-4


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