DOI QR코드

DOI QR Code

Pediatric Severe Traumatic Brain Injury : Updated Management

  • Ha, Eun Jin (Department of Critical Care Medicine, Seoul National University Hospital)
  • 투고 : 2021.12.16
  • 심사 : 2022.03.28
  • 발행 : 2022.05.01

초록

Traumatic brain injury (TBI) is the leading cause of death and disability in children. Survivors of severe TBI are more susceptible to functional deficits, resulting in disability, poor quality of life, cognitive decline, and mental health problems. Despite this, little is known about the pathophysiology of TBI in children and how to manage it most effectively. Internationally, efforts are being made to expand knowledge of pathophysiology and develop practical clinical treatment recommendations to improve outcomes. Here we discuss recently updated evidence and management of severe pediatric TBI.

키워드

참고문헌

  1. Adelson PD, Wisniewski SR, Beca J, Brown SD, Bell M, Muizelaar JP, et al. : Comparison of hypothermia and normothermia after severe traumatic brain injury in children (cool kids): a phase 3, randomised controlled trial. Lancet Neurol 12 : 546-553, 2013 https://doi.org/10.1016/S1474-4422(13)70077-2
  2. Alberico AM, Ward JD, Choi SC, Marmarou A, Young HF : Outcome after severe head injury. Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J Neurosurg 67 : 648-656, 1987 https://doi.org/10.3171/jns.1987.67.5.0648
  3. Alkhoury F, Kyriakides TC : Intracranial pressure monitoring in children with severe traumatic brain injury: national trauma data bank-based review of outcomes. JAMA Surg 149 : 544-548, 2014 https://doi.org/10.1001/jamasurg.2013.4329
  4. Araki T, Yokota H, Morita A : Pediatric traumatic brain injury: characteristic features, diagnosis, and management. Neurol Med Chir (Tokyo) 57 : 82-93, 2017 https://doi.org/10.2176/nmc.ra.2016-0191
  5. Beca J, McSharry B, Erickson S, Yung M, Schibler A, Slater A, et al. : Hypothermia for traumatic brain injury in children-a phase II randomized controlled trial. Crit Care Med 43 : 1458-1466, 2015 https://doi.org/10.1097/CCM.0000000000000947
  6. Bennett TD, Riva-Cambrin J, Keenan HT, Korgenski EK, Bratton SL : Variation in intracranial pressure monitoring and outcomes in pediatric traumatic brain injury. Arch Pediatr Adolesc Med 166 : 641-647, 2012
  7. Biswas AK, Bruce DA, Sklar FH, Bokovoy JL, Sommerauer JF : Treatment of acute traumatic brain injury in children with moderate hypothermia improves intracranial hypertension. Crit Care Med 30 : 2742-2751, 2002 https://doi.org/10.1097/00003246-200212000-00020
  8. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. : Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery 80 : 6-15, 2017 https://doi.org/10.1227/neu.0000000000001432
  9. Chambers IR, Treadwell L, Mendelow AD : Determination of threshold levels of cerebral perfusion pressure and intracranial pressure in severe head injury by using receiver-operating characteristic curves: an observational study in 291 patients. J Neurosurg 94 : 412-416, 2001 https://doi.org/10.3171/jns.2001.94.3.0412
  10. Coronado VG, Xu L, Basavaraju SV, McGuire LC, Wald MM, Faul MD, et al. : Surveillance for traumatic brain injury-related deaths--United States, 1997-2007. MMWR Surveill Summ 60 : 1-32, 2011
  11. Cruz J, Nakayama P, Imamura JH, Rosenfeld KG, De Souza HS, Giorgetti GV : Cerebral extraction of oxygen and intracranial hypertension in severe, acute, pediatric brain trauma: preliminary novel management strategies. Neurosurgery 50 : 774-779, 2002 https://doi.org/10.1097/00006123-200204000-00017
  12. Dewan MC, Mummareddy N, Wellons JC 3rd, Bonfield CM : Epidemiology of global pediatric traumatic brain injury: qualitative review. World Neurosurg 91 : 497-509, 2016 https://doi.org/10.1016/j.wneu.2016.03.045
  13. Downard C, Hulka F, Mullins RJ, Piatt J, Chesnut R, Quint P, et al. : Relationship of cerebral perfusion pressure and survival in pediatric braininjured patients. J Trauma 49 : 654-658, 2000 https://doi.org/10.1097/00005373-200010000-00012
  14. Fisher B, Thomas D, Peterson B : Hypertonic saline lowers raised intracranial pressure in children after head trauma. J Neurosurg Anesthesiol 4 : 4-10, 1992 https://doi.org/10.1097/00008506-199201000-00002
  15. Gardner MT, O'Meara AMI, Miller Ferguson N : Pediatric traumatic brain injury: an update on management. Current Pediatrics Reports 5 : 213-219, 2017 https://doi.org/10.1007/s40124-017-0144-5
  16. Gelineau-Morel RN, Zinkus TP, Le Pichon JB : Pediatric head trauma: a review and update. Pediatr Rev 40 : 468-481, 2019 https://doi.org/10.1542/pir.2018-0257
  17. Haarbauer-Krupa JK, Glang A, Kurowski B, Breiding MJ : Report to congress : the management of traumatic brain injury in children. Available at : https://www.cdc.gov/traumaticbraininjury/pubs/congress-childrentbi.html
  18. Honeybul S, Ho KM, Gillett GR : Long-term outcome following decompressive craniectomy: an inconvenient truth? Curr Opin Crit Care 24 : 97-104, 2018 https://doi.org/10.1097/MCC.0000000000000481
  19. Hutchison JS, Frndova H, Lo TY, Guerguerian AM : Impact of hypotension and low cerebral perfusion pressure on outcomes in children treated with hypothermia therapy following severe traumatic brain injury: a post hoc analysis of the Hypothermia pediatric head injury trial. Dev Neurosci 32 : 406-412, 2010 https://doi.org/10.1159/000323260
  20. Kapapa T, Konig K, Pfister U, Sasse M, Woischneck D, Heissler H, et al. : Head trauma in children, part 2: course and discharge with outcome. J Child Neurol 25 : 274-283, 2010 https://doi.org/10.1177/0883073809332699
  21. Kochanek PM, Clark RS, Ruppel RA, Adelson PD, Bell MJ, Whalen MJ, et al. : Biochemical, cellular, and molecular mechanisms in the evolution of secondary damage after severe traumatic brain injury in infants and children: lessons learned from the bedside. Pediatr Crit Care Med 1 : 4-19, 2000 https://doi.org/10.1097/00130478-200007000-00003
  22. Kochanek PM, Tasker RC, Bell MJ, Adelson PD, Carney N, Vavilala MS, et al. : Management of pediatric severe traumatic brain injury: 2019 consensus and guidelines-based algorithm for first and second tier therapies. Pediatr Crit Care Med 20 : 269-279, 2019 https://doi.org/10.1097/pcc.0000000000001737
  23. Kochanek PM, Tasker RC, Carney N, Totten AM, Adelson PD, Selden NR, et al. : Guidelines for the management of pediatric severe traumatic brain injury, third edition: update of the brain trauma foundation guidelines, executive summary. Neurosurgery 84 : 1169-1178, 2019 https://doi.org/10.1093/neuros/nyz051
  24. Kochanek PM, Tasker RC, Carney N, Totten AM, Adelson PD, Selden NR, et al. : Guidelines for the management of pediatric severe traumatic brain injury, third edition: update of the brain trauma foundation guidelines. Pediatr Crit Care Med 20 : S1-S82, 2019 https://doi.org/10.1097/pcc.0000000000001735
  25. Lewis PM, Czosnyka M, Carter BG, Rosenfeld JV, Paul E, Singhal N, et al. : Cerebrovascular pressure reactivity in children with traumatic brain injury. Pediatr Crit Care Med 16 : 739-749, 2015 https://doi.org/10.1097/PCC.0000000000000471
  26. Nacoti M, Fazzi F, Biroli F, Zangari R, Barbui T, Kochanek PM, et al. : Addressing key clinical care and clinical research needs in severe pediatric traumatic brain injury: perspectives from a focused international conference. Front Pediatr 8 : 594425, 2021 https://doi.org/10.3389/fped.2020.594425
  27. Natale JE, Joseph JG, Helfaer MA, Shaffner DH : Early hyperthermia after traumatic brain injury in children: risk factors, influence on length of stay, and effect on short-term neurologic status. Crit Care Med 28 : 2608-2615, 2000 https://doi.org/10.1097/00003246-200007000-00071
  28. Shein SL, Ferguson NM, Kochanek PM, Bayir H, Clark RS, Fink EL, et al. : Effectiveness of pharmacological therapies for intracranial hypertension in children with severe traumatic brain injury--results from an automated data collection system time-synched to drug administration. Pediatr Crit Care Med 17 : 236-245, 2016 https://doi.org/10.1097/PCC.0000000000000610
  29. Shi J, Xiang H, Wheeler K, Smith GA, Stallones L, Groner J, et al. : Costs, mortality likelihood and outcomes of hospitalized US children with traumatic brain injuries. Brain Inj 23 : 602-611, 2009 https://doi.org/10.1080/02699050903014907
  30. Tremlett W, Kanthimathinathan HK : Cerebral autoregulation monitoring in children with mild traumatic brain injury. Pediatr Crit Care Med 20 : 694-695, 2019 https://doi.org/10.1097/PCC.0000000000001971
  31. Wahlstrom MR, Olivecrona M, Koskinen LO, Rydenhag B, Naredi S : Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy--the lund concept. Intensive Care Med 31 : 832-839, 2005 https://doi.org/10.1007/s00134-005-2632-2
  32. Wang CF, Zhao CC, Jiang G, Gu X, Feng JF, Jiang JY : The role of posttraumatic hypothermia in preventing dendrite degeneration and spine loss after severe traumatic brain injury. Sci Rep 6 : 37063, 2016 https://doi.org/10.1038/srep37063
  33. Yue JK, Rick JW, Deng H, Feldman MJ, Winkler EA : Efficacy of decompressive craniectomy in the management of intracranial pressure in severe traumatic brain injury. J Neurosurg Sci : 425-440, 2019