Morris, Kevin P., Forsyth, Robert J., Parslow, Roger C., Tasker, Robert C. and Hawley, Carol (2006) Intracranial pressure complicating severe traumatic brain injury in children: monitoring and management. INTENSIVE CARE MEDICINE, 32 (10). pp. 1606-1612. doi:10.1007/s00134-006-0285-4 ISSN 0342-4642.

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Abstract

Objective: To identify factors associated with the use of intracranial pressure (ICP) monitoring and to establish which ICP-targetted therapies are being used in children with severe traumatic brain injury (TBI) in the United Kingdom. To evaluate current practice against recently published guidelines. Design and setting: Prospective data collection of clinical and demographic information from paediatric and adult intensive care units in the UK and Ireland admitting children (< 16 years) with TBI between February 2001 and August 2003. Results: Detailed clinical information was obtained for 501 children, with information on the use of ICP monitoring available in 445. ICP monitoring was used in only 59% (75/127) of children presenting with an emergency room Glasgow Coma Scale of 8 or below. Large between centre variation was seen in the use of ICP monitoring, independent of severity of injury. There were 86 children who received ICP-targetted therapies without ICP monitoring. Wide between centre variation was found in the use of ICP-targetted therapies and in general aspects of management, such as fluid restriction, the use of muscle relaxants and prophylactic anticonvulsants. Intraventricular catheters are rarely placed (6% of cases); therefore cerebrospinal fluid drainage is seldom used as a first-line therapy for raised ICP. Jugular venous bulb oximetry (4%), brain microdialysis (< 1%) and brain tissue oxygen monitoring (< 1%) are rarely used in current practice. Contrary to published guidelines, moderate to severe hyperventilation is being used without monitoring for cerebral ischaemia. Conclusions: There is an urgent need for greater standardisation of practice across UK centres admitting children with severe TBI.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Journal or Publication Title:	INTENSIVE CARE MEDICINE
Publisher:	SPRINGER
ISSN:	0342-4642
Official Date:	October 2006
Dates:	Date Event October 2006 UNSPECIFIED
Volume:	32
Number:	10
Number of Pages:	7
Page Range:	pp. 1606-1612
DOI:	10.1007/s00134-006-0285-4
Publication Status:	Published

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