Controversies of prophylactic hypothermia and the emerging use of brain tissue oxygen tension monitoring and decompressive craniectomy in traumatic brain-injured children.
BACKGROUND
Despite being the leading cause of death and disability in the paediatric population, traumatic brain injury (TBI) in this group is largely understudied. Clinical practice within the paediatric intensive care unit (PICU) has been based upon adult guidelines however children are significantly different in terms of mechanism, pathophysiology and consequence of injury.


OBJECTIVE
To review TBI management in the PICU and gain insight into potential management strategies.


METHODS
To conduct this review, a literature search was conducted using MEDLINE, PUBMED and The Cochrane Library using the following key words; traumatic brain injury; paediatric; hypothermia. There were no date restrictions applied to ensure that past studies, whose principles remain current were not excluded.


RESULTS
Three areas were identified from the literature search and will be discussed against current acknowledged treatment strategies: Prophylactic hypothermia, brain tissue oxygen tension monitoring and decompressive craniectomy.


CONCLUSIONS
Previous literature has failed to fully address paediatric specific management protocols and we therefore have little evidence-based guidance. This review has shown that there is an emerging and ongoing trend towards paediatric specific TBI research in particular the area of moderate prophylactic hypothermia (MPH).
Foster
Kelly
K
Paediatric Critical Care Research Group, Paediatric Intensive Care Unit, Mater Children's Hospital, Raymond Terrace, South Brisbane, Queensland 4101, Australia. kelly.foster@mater.org.au
Stocker
Christian
C
Schibler
Andreas
A
D000367:Age Factors; D001923:Brain Chemistry / Q000502:physiology; D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D003422:Critical Care / Q000379:methods* / Q000639:trends; D056424:Decompressive Craniectomy / Q000379:methods; D034462:Dissent and Disputes; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D002534:Hypoxia, Brain / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D015278:Intensive Care Units, Pediatric; D019586:Intracranial Hypertension / Q000209:etiology / Q000517:prevention & control; D008991:Monitoring, Physiologic / Q000379:methods; D010100:Oxygen / Q000032:analysis / Q000378:metabolism; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
D010100:Oxygen