The brain in pediatric critical care: unique aspects of assessment, monitoring, investigations, and follow-up

Kate L Brown^{1

2}, Shruti Agrawal³, Matthew P Kirschen^{4

5}, Chani Traube⁶, Alexis Topjian^{4

5}, Ronit Pressler^{7

8

9}, Cecil D Hahn^{10

11}, Barnaby R Scholefield^{12

13}, Hari Krishnan Kanthimathinathan^{12

13}, Aparna Hoskote^{7

14}, Felice D'Arco^{7

9}, Melania Bembea¹⁵, Joseph C Manning^{16

17}, Maayke Hunfeld^{18

19}, Corinne Buysse¹⁸, Robert C Tasker^{20

21}

Affiliations

¹ Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK. katherine.brown@gosh.nhs.uk.
² Institute of Cardiovascular, Science University College London, London, UK. katherine.brown@gosh.nhs.uk.
³ Paediatric Intensive Care Unit Addenbrookes Hospital, Cambridge, UK.
⁴ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA, Philadelphia.
⁵ University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
⁶ Department of Pediatrics, Division of Pediatric Critical Care Medicine, Weill Cornell Medical College, New York, USA.
⁷ Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK.
⁸ Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, UK.
⁹ University College London Institute of Child Health, London, UK.
¹⁰ Division of Neurology, The Hospital for Sick Children, Toronto, Canada.
¹¹ Department of Paediatrics, University of Toronto, Toronto, Canada.
¹² Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
¹³ Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
¹⁴ Institute of Cardiovascular, Science University College London, London, UK.
¹⁵ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹⁶ Nottingham Children's Hospital and Neonatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁷ Centre for Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK.
¹⁸ Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
¹⁹ Department of Pediatric Neurology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
²⁰ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
²¹ Selwyn College, Cambridge University, Cambridge, UK.

PMID: 35445823
PMCID: PMC10082392
DOI: 10.1007/s00134-022-06683-4

Review

The brain in pediatric critical care: unique aspects of assessment, monitoring, investigations, and follow-up

Kate L Brown et al. Intensive Care Med. 2022 May.

. 2022 May;48(5):535-547.

doi: 10.1007/s00134-022-06683-4. Epub 2022 Apr 21.

Authors

Affiliations

¹ Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK. katherine.brown@gosh.nhs.uk.
² Institute of Cardiovascular, Science University College London, London, UK. katherine.brown@gosh.nhs.uk.
³ Paediatric Intensive Care Unit Addenbrookes Hospital, Cambridge, UK.
⁴ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA, Philadelphia.
⁵ University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
⁶ Department of Pediatrics, Division of Pediatric Critical Care Medicine, Weill Cornell Medical College, New York, USA.
⁷ Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK.
⁸ Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, UK.
⁹ University College London Institute of Child Health, London, UK.
¹⁰ Division of Neurology, The Hospital for Sick Children, Toronto, Canada.
¹¹ Department of Paediatrics, University of Toronto, Toronto, Canada.
¹² Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
¹³ Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
¹⁴ Institute of Cardiovascular, Science University College London, London, UK.
¹⁵ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹⁶ Nottingham Children's Hospital and Neonatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁷ Centre for Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK.
¹⁸ Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
¹⁹ Department of Pediatric Neurology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
²⁰ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
²¹ Selwyn College, Cambridge University, Cambridge, UK.

PMID: 35445823
PMCID: PMC10082392
DOI: 10.1007/s00134-022-06683-4

Abstract

As survival after pediatric intensive care unit (PICU) admission has improved over recent years, a key focus now is the reduction of morbidities and optimization of quality of life for survivors. Neurologic disorders and direct brain injuries are the reason for 11-16% of admissions to PICU. In addition, many critically ill children are at heightened risk of brain injury and neurodevelopmental difficulties affecting later life, e.g., complex heart disease and premature birth. Hence, assessment, monitoring and protection of the brain, using fundamental principles of neurocritical care, are crucial to the practice of pediatric intensive care medicine. The assessment of brain function, necessary to direct appropriate care, is uniquely challenging amongst children admitted to the PICU. Challenges in assessment arise in children who are unstable, or pharmacologically sedated and muscle relaxed, or who have premorbid abnormality in development. Moreover, the heterogeneity of diseases and ages in PICU patients, means that high caliber evidence is harder to accrue than in adult practice, nonetheless, great progress has been made over recent years. In this 'state of the art' paper about critically ill children, we discuss (1) patient types at risk of brain injury, (2) new standardized clinical assessment tools for age-appropriate, clinical evaluation of brain function, (3) latest evidence related to cranial imaging, non-invasive and invasive monitoring of the brain, (4) the concept of childhood 'post intensive are syndrome' and approaches for neurodevelopmental follow-up. Better understanding of these concepts is vital for taking PICU survivorship to the next level.

Keywords: Brain injury; Neurodevelopment; Pediatric intensive care.

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Conflict of interest statement

COI Statement: RP is an investigator for studies with UCB and does consultancy work for Kephala, Ireland. She served as a Speaker and/or on Advisory Boards for Natus, GW, Esai, and UCB. The other authors declare no conflict of interest.

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References

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The brain in pediatric critical care: unique aspects of assessment, monitoring, investigations, and follow-up

Affiliations

The brain in pediatric critical care: unique aspects of assessment, monitoring, investigations, and follow-up

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials