Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009;3(6):533-541.
doi: 10.2217/phe.09.54.

Emergency treatment options for pediatric traumatic brain injury

J Exo  1 , C Smith, R Smith, Mj Bell
Affiliations

Emergency treatment options for pediatric traumatic brain injury

J Exo et al. Ped Health. 2009.

Abstract

Traumatic brain injury is a leading killer of children and is a major public health problem around the world. Using general principles of neurocritical care, various treatment strategies have been developed to attempt to restore homeostasis to the brain and allow brain healing, including mechanical factors, cerebrospinal fluid diversion, hyperventilation, hyperosmolar therapies, barbiturates and hypothermia. Careful application of these therapies, normally in a step-wise fashion as intracranial injuries evolve, is necessary in order to attain maximal neurological outcome for these children. It is hopeful that new therapies, such as early hypothermia or others currently in preclinical trials, will ultimately improve outcome and quality of life for children after traumatic brain injury.

PubMed Disclaimer

Figures

Figure 1
Figure 1. The Munro–Kellie Doctrine explains the relationship between intracranial volumes and intracranial pressure in physiological and pathophysiological conditions
The volume of the intracranial vault (the area represented by the rectangle) is generally fixed in adults and most children. The contents of the intracranial vault in the normal condition include the brain, arterial blood, venous blood and CSF, and are maintained at a relatively low ICP (Panel 1; normal). After an injury, swelling/edema/pathological tissue can increase within the brain (Panel 2; compensated). Compensatory mechanisms, including increased CSF absorption, extrusion of CSF into the spinal canal and extrusion of venous blood into the thorax, initially limit any changes in ICP. When these compensatory changes are exhausted (Panel 3; uncompensated), any further increases in intracranial volumes are associated with concomitant increases in ICP that eventually can compromise arterial blood flow, ultimately leading to cerebral herniation. CSF: Cerebrospinal fluid; ICP: Intracranial pressure.
See this image and copyright information in PMC

References

    1. Kung HC, Hoyert DL, Xu J, et al. Deaths: final data for 2005. National Vital Statistics Reports. 2008. pp. 1–121. - PubMed
    1. Luerssen TG, Klauber MR, Marshall LF. Outcome from head injury related to patient’s age. A longitudinal prospective study of adult and pediatric head injury. J. Neurosurg. 1988;68(3):409–416. - PubMed
    1. Cohadon F, Richer E, Castel JP. Head injuries: incidence and outcome. J. Neurol. Sci. 1991;103 Suppl.:S27–S31. - PubMed
    1. Frankowski R, Annegers J, Whitman S. Epidemiology and descriptive studies. Part 1. The descriptive epidemiology of head trauma in the United States. In: Becker DP, Povlishock J, editors. Central Nervous System Trauma Status Report –1985. Bethesda, MD, USA: NIH, NINDS; 1985. pp. 33–43.

    1. Adelson PD, Bratton SL, Carney NA, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Pediatr. Crit. Care Med. 2003;4(3 Suppl):S1–S73. •• The most recent version of comprehensive guidelines for the management of children after severe traumatic brain injury (TBI) – a revision of these guidelines is now ongoing and expected to be published within several months

LinkOut - more resources