Overview
This guideline is specific to children with traumatic brain injury (TBI) requiring intubation. It is based in large part on the recently published 2019 international pediatric traumatic brain injury (TBI) guidelines and so focuses predominantly on patients admitted to the PICU with an intracranial pressure monitor. Links have been provided to these resources. An attempt has been made to suggest a sequential approach to second-line therapies reserved for refractory intracranial hypertension but where evidence is less robust. Finally, recognizing that some patients are managed without intracranial pressure monitors or only require intubation for more transient conditions such as post-traumatic seizures, a clinical pathway that includes these different scenarios has been included.
Most Recent References
Age-Specific Cerebral Perfusion Pressure Thresholds and Survival in Children and Adolescents with Severe TBI. Baxter B. Allen, et al. Pediatric Critical Care Medicine: November 23, 2020
Effects of tranexamic acid on death, disability, vascular occlusive events and other mordibities in patients with acute TBI (CRASH-3): a randomixed controlled trial. CRASH-3trial contributors. Lancet 2019: 394: 1713-23
Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines. Kochanek PM, Tasker RC, Carney N, et al. Pediatr Crit Care Med 2019;20:S1-S82.