Pediatric Severe Traumatic Brain Injury Management

Abstract

TBI is the leading cause of death in children in the United States. The burden of pediatric TBI (pTBI) is expected to exceed $30 billion annually within the United States. in pTBI, the primary injury consists of damage to the brain itself, hematomas that occur around the brain and other damage to the cranium and blood vessels of the brain. After the primary injury, pathological processes evolve over hours to days that can lead secondary injury. These include alterations in cerebral blood flow, cerebral swelling, intracranial pressure, seizures, and altered brain metabolism. Currently mechanical therapies include surgical evacuation, cerebrospinal fluid drainage, therapeutic maneuvers: hyperventilation. Medication include hyperosmolar therapies, barbiturates and drug-induced coma and experimental therapy also include hypothermia. In summary, evidenced-based guidelines of pTBI care are still limited. Future research should focus on establishing higher levels of evidence and working toward personalizing the care of pTBI patients.