Traumatic Brain Injury

Faruk EKİNCİa , Rıza Dinçer YILDIZDAŞa

aÇukurova University Faculty of Medicine, Department of Pediatric Intensive Care, Adana, Türkiye

ABSTRACT
Pediatric traumatic brain injury (TBI) is a worldwide healthcare concern that is associated with relatively high mortality rates and is a potential for long term disabilities that may affect an entire lifespan of a child. Motor vehicle accidents, falls from height, abusive head trauma, and sports injuries account for most of traumatic brain injuries. Although mild TBIs generally represent most of the study population in pediatric literature, some studies are also available which represent severe TBI constitute more than a half of the study population. After initial evaluation, resuscitation, and stabilization, detailed monitoring and titrated management of elevated intracranial pressure is essential to optimize cerebral perfusion which is vital to maintain metabolic homeostasis of the brain. To decrease elevated ICP in conjunction with avoiding hypoxemia and hypotension allows the maintenance of adequate cerebral perfusion pressure and cerebral oxygenation thus needed for the best neurologic outcomes and brain recovery. The latest pediatric guidelines making consensus-based recommendations for the management of pediatric severe traumatic brain injury provides a more comprehensive overview of the approaches to ”baseline care”, ”first tier therapy”, ”second tier therapy” and ”herniation pathway”. The algorithm requires insertion of an intracranial pressure catheter to guide adequate and appropriate therapy in conjunction with neurologic examination, laboratory, and neuroimaging findings. Cerebrospinal fluid drainage, hyperosmolar therapy, sedation and analgesia, and neuromuscular blockade constitute first tier therapy whereas surgical intervention involving decompressive craniectomy, barbiturate infusion, moderate hypothermia, hyperventilation, and higher levels of hyperosmolar therapy generate second tier therapy.
Keywords: Brain injury, traumatic; head trauma; intracranial pressure; cerebral edema; standarts

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