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

Morris, Kevin P.; Forsyth, Robert J.; Parslow, Roger C.; Tasker, Robert C.; Hawley, Carol A.; UK Paediatric Traumatic Brain Injury Study Group; Paediatric Intensive Care Society Study Group
October 2006
Intensive Care Medicine;Oct2006, Vol. 32 Issue 10, p1606
Academic Journal
journal article
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.


Related Articles

  • Visualizing secondary brain insults: does the emperor have new clothes? Asehnoune, Karim; Hemphill, J.; Agbeko, Rachel // Intensive Care Medicine;Jul2015, Vol. 41 Issue 7, p1324 

    The author discusses the management of patients with severe traumatic brain injury (TBI). Topics covered include the negative effects of persistently elevated intracranial pressure (ICP) after TBI and how the status of pressure autoregulation in an individual patient has a significant role in...

  • Lityum kullanımına baÄŸlı geliÅŸen psödotümör serebri: Olgu sunumu. KÖYBAŞI, Gülperi PUTGÜL; GÜLPEK, Demet // Anatolian Journal of Psychiatry / Anadolu Psikiyatri Dergisi;Mar2012, Vol. 13 Issue 1, p85 

    Progress of pseudotumor cerebri (PC) due to use of lithium is observed very rarely and it is included in the literature as case reports. PC is defined as increase of intracranial pressure in the absence of a structural lesion such as intracranial space occupying lesion, meningeal inflammation or...

  • compression.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p502 

    A definition of the term "compression" is presented. It refers to the condition of being pressed together. In medicine, it may also refer to breast compression or cerebral compression, a condition which is marked by alterations of consciousness and nausea. Patients suffering from cerebral...

  • Minocycline-associated Idiopathic Intracranial Hypertension In A Patient Presenting To The Emergency Department. Targonski, Paul Victor; Schiebel, Nicola E; Lucchinetti, Claudia N // Internet Journal of Pharmacology;2002, Vol. 1 Issue 2, p28 

    The article reports a case of minocycline-associated idiopathic intracranial hypertension (IIH) in a young female presented to an emergency department for evaluation of headaches with visual changes. IIH is a condition characterized by signs and symptoms of increased intracranial pressure (ICP),...

  • A Review of Non-Invasive Methods of Monitoring Intracranial Pressure. Asiedua, Derek Pobi; Kyoung-Jae Leeb; Millsa, Godfrey; Kaufmannc, Elsie Effah // Journal of Neurology Research;2014, Vol. 4 Issue 1, p1 

    Intracranial pressure (ICP) monitoring is an important aspect of neuro-medicine. ICP is the pressure created by the presence of cerebrospinal fluid. ICP monitoring techniques consist of invasive (in vivo) and non-invasive methods (in vitro). Modern research aims to eliminate invasive monitoring...

  • Je rozdiel v prežívaní pacientov s kraniocerebrálnym poranením s meraným a nemeraným intrakraniálnym tlakom? Štefan, Krbila; Viliam, Soboňa; Iveta, Waczulíková; Roman, Záhorec // Anaesthesiology & Intensive Medicine / Anesteziologie a Intenziv;Oct2011, Vol. 22 Issue 5, p272 

    Objective: To compare the outcomes and mortality at 7 and 270 days in brain-injured patients with an inserted ICP sensor to those without an ICP sensor. Type of study: Prospective and comparative clinical study. Materials and methods: The study population, which consisted of 64 patients with...

  • Therapie des schweren Schädel-Hirn-Traumas. Engelhard, K.; Müller-Forell, W.; Werner, C. // Anaesthesist;Dec2008, Vol. 57 Issue 12, p1219 

    The main target of treatment in patients with head trauma is to maintain the physiological parameters within the following normal limits: intracranial pressure (ICP) below 20 mmHg, cerebral perfusion pressure (CPP) between 50 and 70 mmHg, normoxemia (SpO2 >90%), normocapnia (paCO2: 35–38...

  • Pattern of regional white matter CBF in normal pressure hydrocephalus during infusion test. Momjian, S.; Owler, B. K.; Czosnyka, Z.; Czosnyka, M.; Pena, A.; Pickard, J. D. // Cerebrospinal Fluid Research;2004 Supplement 1, Vol. 1, pS14 

    The article assesses the distribution of baseline and change of regional white matter (WM) cerebral blood flow (CBF) in normal pressure hydrocephalus (NPH) before and during a controlled rise of intracranial pressure. According to the authors, the increasing profile of WM baseline CBF might...

  • Craniectomy in severe, life-threatening encephalitis: a report on outcome and long-term prognosis of four cases. Taferner, E.; Pfausler, B.; Kofler, A.; Spiss, H.; Engelhardt, K.; Kampfl, A.; Schmutzhard, E. // Intensive Care Medicine;Aug2001, Vol. 27 Issue 8, p1426 

    Objective:To report the feasibility of craniectomy with duraplasty in four patients with life-threatening encephalitis and, in particular, their long-term outcome. Design: Report of four cases, analysis of the acute clinical course and neurological long-term sequelae. Results: Generous...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics