Traumatic brain injury in infants and children: mechanisms of secondary damage and treatment in the intensive care unit.
Unfortunately no specific pharmacologic therapies are available for the treatment of TBI in patients. Current investigation of contemporary therapies for the treatment of TBI consists of recycling of previously tested therapies in the era of contemporary neurointensive care. These therapies include hypothermia, decompressive craniectomy, osmotherapy, and controlled hyperventilation. It is hoped that more detailed knowledge regarding the dominant pathophysiologic mechanisms associated with TBI-excitotoxicity, CBF dysregulation, oxidative stress, and programmed cell death-will catapult an efficacious intervention from the laboratory bench to the bedside. This intervention may be a potent agent targeting a single dominant pathway, a broad-spectrum intervention such as hypothermia, or, more likely, a combination of therapies. Meanwhile, practitioners must offer meticulous supportive neurointensive care using clinically proven therapies aimed at minimizing cerebral swelling for the management of pediatric patients who are victims of TBI.
Bayir
Hülya
H
Department of Anesthesiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Kochanek
Patrick M
PM
Clark
Robert S B
RS
D017209:Apoptosis; D001929:Brain Edema / Q000503:physiopathology; D001930:Brain Injuries / Q000503:physiopathology* / Q000628:therapy*; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007249:Inflammation; D015278:Intensive Care Units, Pediatric; D018384:Oxidative Stress