Skip to main content
SpringerLink
Log in
Book cover

Pediatric Surgery pp 1–16Cite as

Conservative Management of Severe Cerebral Trauma

  • Living reference work entry
  • First Online:

  • 148 Accesses

Abstract

Traumatic brain injury (TBI) is a common cause for death in children and adolescents. The underlying brain injury can be categorized into primary lesions caused by the immediate effects of the trauma and secondary lesions due to inflammation, hypoxia, hypotension, hyperthermia, and other metabolic processes. Modern intensive care lies in the prevention of these secondary lesions by correct patient positioning, monitoring of intracranial pressure with rapid therapy of intracranial hypertension (deep sedation, osmotic therapy, barbiturates, liquor drainage), early neurosurgical intervention, and glucose and temperature control. This chapter summarizes current literature and guidelines for conservative management of TBI patients from shock room to advanced intensive care.

This is a preview of subscription content, log in via an institution.

References

  • Adelson PD. Hypothermia following pediatric traumatic brain injury. J Neurotrauma. 2009;26(3):429–36.

    Article  PubMed  PubMed Central  Google Scholar 

  • Adelson PD, Dixon CE, Robichaud P, Kochanek PM. Motor and cognitive functional deficits following diffuse traumatic brain injury in the immature rat. J Neurotrauma. 1997;14(2):99–108.

    Article  CAS  PubMed  Google Scholar 

  • Adelson PD, Ragheb J, Kanev P, Brockmeyer D, Beers SR, Brown SD, Cassidy LD, Chang Y, Levin H. Phase II clinical trial of moderate hypothermia after severe traumatic brain injury in children. Neurosurgery. 2005;56(4):740–54; discussion 740–754.

    Article  PubMed  Google Scholar 

  • Adelson PD, Wisniewski SR, Beca J, Brown SD, Bell M, Muizelaar JP, Okada P, Beers SR, Balasubramani GK, Hirtz D, Paediatric Traumatic Brain Injury Consortium. Comparison of hypothermia and normothermia after severe traumatic brain injury in children (Cool Kids): a phase 3, randomised controlled trial. Lancet Neurol. 2013;12(6):546–53.

    Article  PubMed  Google Scholar 

  • Alberico AM, Ward JD, Choi SC, Marmarou A, Young HF. Outcome after severe head injury. Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J Neurosurg. 1987;67(5):648–56.

    Article  CAS  PubMed  Google Scholar 

  • Allen BB, Chiu YL, Gerber LM, Ghajar J, Greenfield JP. Age-specific cerebral perfusion pressure thresholds and survival in children and adolescents with severe traumatic brain injury∗. Pediatr Crit Care Med. 2014;15(1):62–70.

    Article  PubMed  PubMed Central  Google Scholar 

  • Arjamaa O, Karlqvist K, Kanervo A, Vainionpaa V, Vuolteenaho O, Leppaluoto J. Plasma ANP during hypertonic NaCl infusion in man. Acta Physiol Scand. 1992;144(2):113–9.

    Article  CAS  PubMed  Google Scholar 

  • Arndt DH, Lerner JT, Matsumoto JH, Madikians A, Yudovin S, Valino H, McArthur DL, Wu JY, Leung M, Buxey F, Szeliga C, Van Hirtum-Das M, Sankar R, Brooks-Kayal A, Giza CC. Subclinical early posttraumatic seizures detected by continuous EEG monitoring in a consecutive pediatric cohort. Epilepsia. 2013;54(10):1780–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Baldwin HZ, Rekate HL. Preliminary experience with controlled external lumbar drainage in diffuse pediatric head injury. Pediatr Neurosurg. 1991;17(3):115–20.

    Article  PubMed  Google Scholar 

  • Bar-Joseph G, Guilburd Y, Tamir A, Guilburd JN. Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension. J Neurosurg Pediatr. 2009;4(1):40–6.

    Article  PubMed  Google Scholar 

  • Barzilay Z, Somekh E. Diabetes insipidus in severely brain damaged children. J Med. 1988;19(1):47–64.

    CAS  PubMed  Google Scholar 

  • Bhalla T, Dewhirst E, Sawardekar A, Dairo O, Tobias JD. Perioperative management of the pediatric patient with traumatic brain injury. Paediatr Anaesth. 2012;22(7):627–40.

    Article  PubMed  Google Scholar 

  • Bhullar IS, Johnson D, Paul JP, Kerwin AJ, Tepas JJ 3rd, Frykberg ER. More harm than good: antiseizure prophylaxis after traumatic brain injury does not decrease seizure rates but may inhibit functional recovery. J Trauma Acute Care Surg. 2014;76(1):54–60; discussion 60–51.

    Article  CAS  PubMed  Google Scholar 

  • Bouma GJ, Muizelaar JP, Stringer WA, Choi SC, Fatouros P, Young HF. Ultra-early evaluation of regional cerebral blood flow in severely head-injured patients using xenon-enhanced computerized tomography. J Neurosurg. 1992;77(3):360–8.

    Article  CAS  PubMed  Google Scholar 

  • Bramwell KJ, Haizlip J, Pribble C, VanDerHeyden TC, Witte M. The effect of etomidate on intracranial pressure and systemic blood pressure in pediatric patients with severe traumatic brain injury. Pediatr Emerg Care. 2006;22(2):90–3.

    Article  PubMed  Google Scholar 

  • Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176(2):289–96.

    Article  CAS  PubMed  Google Scholar 

  • Chambers IR, Treadwell L, Mendelow AD. Determination of threshold levels of cerebral perfusion pressure and intracranial pressure in severe head injury by using receiver-operating characteristic curves: an observational study in 291 patients. J Neurosurg. 2001;94(3):412–6.

    Article  CAS  PubMed  Google Scholar 

  • Chen HI, Malhotra NR, Oddo M, Heuer GG, Levine JM, LeRoux PD. Barbiturate infusion for intractable intracranial hypertension and its effect on brain oxygenation. Neurosurgery. 2008;63(5):880–6; discussion 886–887.

    Article  PubMed  Google Scholar 

  • Chernow B, Lake CR, Cruess D, Coyle J, Hughes P, Balestrieri F, Casey L, Rainey TG, Fletcher JR. Plasma, urine, and CSF catecholamine concentrations during and after ketamine anesthesia. Crit Care Med. 1982;10(9):600–3.

    Article  CAS  PubMed  Google Scholar 

  • Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA. The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 1993;34(2):216–22.

    Article  CAS  PubMed  Google Scholar 

  • Clark RS, Kochanek PM, Marion DW, Schiding JK, White M, Palmer AM, DeKosky ST. Mild posttraumatic hypothermia reduces mortality after severe controlled cortical impact in rats. J Cereb Blood Flow Metab. 1996;16(2):253–61.

    Article  CAS  PubMed  Google Scholar 

  • Cochran A, Scaife ER, Hansen KW, Downey EC. Hyperglycemia and outcomes from pediatric traumatic brain injury. J Trauma. 2003;55(6):1035–8.

    Article  PubMed  Google Scholar 

  • Cruz J, Nakayama P, Imamura JH, Rosenfeld KG, de Souza HS, Giorgetti GV. Cerebral extraction of oxygen and intracranial hypertension in severe, acute, pediatric brain trauma: preliminary novel management strategies. Neurosurgery. 2002;50(4):774–9; discussion 779–780.

    Article  PubMed  Google Scholar 

  • Curry R, Hollingworth W, Ellenbogen RG, Vavilala MS. Incidence of hypo- and hypercarbia in severe traumatic brain injury before and after 2003 pediatric guidelines. Pediatr Crit Care Med. 2008;9(2):141–6.

    Article  PubMed  Google Scholar 

  • Da Silva PSL, Reis ME, Aguiar VE. Value of repeat cranial computed tomography in pediatric patients sustaining moderate to severe traumatic brain injury. J Trauma. 2007;65(5):1293–7.

    Google Scholar 

  • Davis DP, Koprowicz KM, Newgard CD, Daya M, Bulger EM, Stiell I, Nichol G, Stephens S, Dreyer J, Minei J, Kerby JD. The relationship between out-of-hospital airway management and outcome among trauma patients with Glasgow Coma Scale Scores of 8 or less. Prehosp Emerg Care. 2011;15(2):184–92.

    Article  PubMed  PubMed Central  Google Scholar 

  • den Brinker M, Hokken-Koelega AC, Hazelzet JA, de Jong FH, Hop WC, Joosten KF. One single dose of etomidate negatively influences adrenocortical performance for at least 24h in children with meningococcal sepsis. Intensive Care Med. 2008;34(1):163–8.

    Article  CAS  Google Scholar 

  • Dominguez TE, Priestley MA, Huh JW. Caution should be exercised when maintaining a serum sodium level >160 meq/L. Crit Care Med. 2004;32(6):1438–9; author reply 1439–1440.

    Article  PubMed  Google Scholar 

  • Dong XQ, Huang M, Yang SB, Yu WH, Zhang ZY. Copeptin is associated with mortality in patients with traumatic brain injury. J Trauma. 2011;71(5):1194–8.

    Article  CAS  PubMed  Google Scholar 

  • Duhaime AC, Christian CW, Rorke LB, Zimmerman RA. Nonaccidental head injury in infants – the “shaken-baby syndrome”. N Engl J Med. 1998;338(25):1822–9.

    Article  CAS  PubMed  Google Scholar 

  • Exo J, Kochanek PM, Adelson PD, Greene S, Clark RS, Bayir H, Wisniewski SR, Bell MJ. Intracranial pressure-monitoring systems in children with traumatic brain injury: combining therapeutic and diagnostic tools. Pediatr Crit Care Med. 2011;12(5):560–5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fanconi S, Kloti J, Meuli M, Zaugg H, Zachmann M. Dexamethasone therapy and endogenous cortisol production in severe pediatric head injury. Intensive Care Med. 1988;14(2):163–6.

    Article  CAS  PubMed  Google Scholar 

  • Figaji AA, Zwane E, Thompson C, Fieggen AG, Argent AC, Le Roux PD, Peter JC. Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury. Part 1: relationship with outcome. Childs Nerv Syst. 2009;25(10):1325–33.

    Article  PubMed  Google Scholar 

  • Figg RE, Stouffer CW, Vander Kolk WE, Connors RH. Clinical efficacy of serial computed tomographic scanning in pediatric severe traumatic brain injury. Pediatr Surg Int. 2006;22(3):215–8.

    Article  PubMed  Google Scholar 

  • Fisher B, Thomas D, Peterson B. Hypertonic saline lowers raised intracranial pressure in children after head trauma. J Neurosurg Anesthesiol. 1992;4(1):4–10.

    Article  CAS  PubMed  Google Scholar 

  • Food and Drug Administration. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm172351.htm. Last accessed 2015.

  • Goodman JC, Valadka AB, Gopinath SP, Cormio M, Robertson CS. Lactate and excitatory amino acids measured by microdialysis are decreased by pentobarbital coma in head-injured patients. J Neurotrauma. 1996;13(10):549–56.

    Article  CAS  PubMed  Google Scholar 

  • Greve MW, Zink BJ. Pathophysiology of traumatic brain injury. Mt Sinai J Med. 2009;76(2):97–104.

    Article  PubMed  Google Scholar 

  • Guerra SD, Carvalho LF, Affonseca CA, Ferreira AR, Freire HB. Factors associated with intracranial hypertension in children and teenagers who suffered severe head injuries. J Pediatr. 2010;86(1):73–9.

    Google Scholar 

  • Hall P, Adami HO, Trichopoulos D, Pedersen NL, Lagiou P, Ekbom A, Ingvar M, Lundell M, Granath F. Effect of low doses of ionising radiation in infancy on cognitive function in adulthood: Swedish population based cohort study. BMJ. 2004;328(7430):19.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hardcastle N, Benzon HA, Vavilala MS. Update on the 2012 guidelines for the management of pediatric traumatic brain injury – information for the anesthesiologist. Paediatr Anaesth. 2014;24(7):703–10.

    Article  PubMed  PubMed Central  Google Scholar 

  • Harrigan MR. Cerebral salt wasting syndrome: a review. Neurosurgery. 1996;38(1):152–60.

    Article  CAS  PubMed  Google Scholar 

  • Himmelseher S. Hypertonic saline solutions for treatment of intracranial hypertension. Curr Opin Anaesthesiol. 2007;20(5):414–26.

    Article  PubMed  Google Scholar 

  • Hollingworth W, Vavilala MS, Jarvik JG, Chaudhry S, Johnston BD, Layman S, Tontisirin N, Muangman SL, Wang MC. The use of repeated head computed tomography in pediatric blunt head trauma: factors predicting new and worsening brain injury. Pediatr Crit Care Med. 2007;8(4):348–56; CEU quiz 357.

    PubMed  Google Scholar 

  • Holly LT, Kelly DF, Counelis GJ, Blinman T, McArthur DL, Cryer HG. Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics. J Neurosurg. 2002;96(3 Suppl):285–91.

    PubMed  Google Scholar 

  • Hung OR, Hare GM, Brien S. Head elevation reduces head-rotation associated increased ICP in patients with intracranial tumours. Can J Anaesth. 2000;47(5):415–20.

    Article  CAS  PubMed  Google Scholar 

  • Hutchison JS, Ward RE, Lacroix J, Hebert PC, Barnes MA, Bohn DJ, Dirks PB, Doucette S, Fergusson D, Gottesman R, Joffe AR, Kirpalani HM, Meyer PG, Morris KP, Moher D, Singh RN, Skippen PW, Hypothermia Pediatric Head Injury Trial Investigators and the Canadian Critical Care Trials Group. Hypothermia therapy after traumatic brain injury in children. N Engl J Med. 2008;358(23):2447–56.

    Article  CAS  PubMed  Google Scholar 

  • Investigators SS, Australian, New Zealand Intensive Care Society Clinical Trials Group, Australian Red Cross Blood Service, George Institute for International Health, Myburgh J, Cooper DJ, Finfer S, Bellomo R, Norton R, Bishop N, Kai Lo S, Vallance S. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med. 2007;357(9):874–84.

    Article  Google Scholar 

  • Ishibashi A, Yokokura Y. Asymptomatic hyponaturemia in a patient with mild head injury due to syndrome of inappropriate diuretic hormone – a case report. Kurume Med J. 1999;46(2):123–5.

    Article  CAS  PubMed  Google Scholar 

  • Jagannathan J, Okonkwo DO, Yeoh HK, Dumont AS, Saulle D, Haizlip J, Barth JT, Jane JA Sr, Jane JA Jr. Long-term outcomes and prognostic factors in pediatric patients with severe traumatic brain injury and elevated intracranial pressure. J Neurosurg Pediatr. 2008;2(4):240–9.

    Article  PubMed  Google Scholar 

  • James HE. Methodology for the control of intracranial pressure with hypertonic mannitol. Acta Neurochir. 1980;51(3–4):161–72.

    Article  CAS  PubMed  Google Scholar 

  • Jimenez R, Casado-Flores J, Nieto M, Garcia-Teresa MA. Cerebral salt wasting syndrome in children with acute central nervous system injury. Pediatr Neurol. 2006;35(4):261–3.

    Article  PubMed  Google Scholar 

  • Kaieda R, Todd MM, Cook LN, Warner DS. Acute effects of changing plasma osmolality and colloid oncotic pressure on the formation of brain edema after cryogenic injury. Neurosurgery. 1989;24(5):671–8.

    Article  CAS  PubMed  Google Scholar 

  • Kasoff SS, Lansen TA, Holder D, Filippo JS. Aggressive physiologic monitoring of pediatric head trauma patients with elevated intracranial pressure. Pediatr Neurosci. 1988;14(5):241–9.

    Article  CAS  PubMed  Google Scholar 

  • Kaufmann AM, Cardoso ER. Aggravation of vasogenic cerebral edema by multiple-dose mannitol. J Neurosurg. 1992;77(4):584–9.

    Article  CAS  PubMed  Google Scholar 

  • Khanna S, Davis D, Peterson B, Fisher B, Tung H, O’Quigley J, Deutsch R. Use of hypertonic saline in the treatment of severe refractory posttraumatic intracranial hypertension in pediatric traumatic brain injury. Crit Care Med. 2000;28(4):1144–51.

    Article  CAS  PubMed  Google Scholar 

  • Kochanek PM. Pediatric traumatic brain injury: quo vadis? Dev Neurosci. 2006;28(4–5):244–55.

    Article  CAS  PubMed  Google Scholar 

  • Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, Carson S, Chesnut RM, Ghajar J, Goldstein B, Grant GA, Kissoon N, Peterson K, Selden NR, Tasker RC, Tong KA, Vavilala MS, Wainwright MS, Warden CR, American Academy of Pediatrics-Section on Neurological Surgery, American Association of Neurological Surgeons/Congress of Neurological Surgeons, Child Neurology Society, European Society of Pediatric, Neonatal Intensive Care, Neurocritical Care Society, Pediatric Neurocritical Care Research Group, Society of Critical Care Medicine, Paediatric Intensive Care Society UK, Society for Neuroscience in Anesthesiology and Critical Care, World Federation of Pediatric Intensive and Critical Care Societies. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents – second edition. Pediatr Crit Care Med. 2012;13(Suppl 1):S1–82.

    PubMed  Google Scholar 

  • Kochanek PM, Tasker RC, Carney N, et al. Guidelines for the management of pediatric severe traumatic brain injury, third edition: update of the brain trauma foundation guidelines, executive summary. Pediatr Crit Care Med. 2019;20(3):280–9.

    Article  PubMed  Google Scholar 

  • Lang EW, Mulvey JM, Mudaliar Y, Dorsch NW. Direct cerebral oxygenation monitoring – a systematic review of recent publications. Neurosurg Rev. 2007;30(2):99–106; discussion 106–107

    Article  PubMed  Google Scholar 

  • Langlois JA, Rutland-Brown W, Thomas KE. The incidence of traumatic brain injury among children in the United States: differences by race. J Head Trauma Rehabil. 2005;20(3):229–38.

    Article  PubMed  Google Scholar 

  • Larach MG, Rosenberg H, Gronert GA, Allen GC. Hyperkalemic cardiac arrest during anesthesia in infants and children with occult myopathies. Clin Pediatr (Phila). 1997;36(1):9–16.

    Article  CAS  Google Scholar 

  • Levy DI, Rekate HL, Cherny WB, Manwaring K, Moss SD, Baldwin HZ. Controlled lumbar drainage in pediatric head injury. J Neurosurg. 1995;83(3):453–60.

    Article  CAS  PubMed  Google Scholar 

  • Lohani S, Devkota UP. Hyponatremia in patients with traumatic brain injury: etiology, incidence, and severity correlation. World Neurosurg. 2011;76(3–4):355–60.

    Article  PubMed  Google Scholar 

  • Mansfield RT, Schiding JK, Hamilton RL, Kochanek PM. Effects of hypothermia on traumatic brain injury in immature rats. J Cereb Blood Flow Metab. 1996;16(2):244–52.

    Article  CAS  PubMed  Google Scholar 

  • Mattei TA, Bond BJ, Goulart CR, Sloffer CA, Morris MJ, Lin JJ. Performance analysis of the protective effects of bicycle helmets during impact and crush tests in pediatric skull models. J Neurosurg Pediatr. 2012;10(6):490–7.

    Article  PubMed  Google Scholar 

  • McLaughlin MR, Marion DW. Cerebral blood flow and vasoresponsivity within and around cerebral contusions. J Neurosurg. 1996;85(5):871–6.

    Article  CAS  PubMed  Google Scholar 

  • McLean L, Russell K, McFaull S, et al. Age and the risk of All-Terrain Vehicle-related injuries in children and adolescents: a cross sectional study. BMC Pediatr. 2017;17(1):81.

    Article  PubMed  PubMed Central  Google Scholar 

  • Metz C, Holzschuh M, Bein T, Woertgen C, Frey A, Frey I, Taeger K, Brawanski A. Moderate hypothermia in patients with severe head injury: cerebral and extracerebral effects. J Neurosurg. 1996;85(4):533–41.

    Article  CAS  PubMed  Google Scholar 

  • Minton MD, Grosslight K, Stirt JA, Bedford RF. Increases in intracranial pressure from succinylcholine: prevention by prior nondepolarizing blockade. Anesthesiology. 1986;65(2):165–9.

    Article  CAS  PubMed  Google Scholar 

  • Muizelaar JP, Lutz HA 3rd, Becker DP. Effect of mannitol on ICP and CBF and correlation with pressure autoregulation in severely head-injured patients. J Neurosurg. 1984;61(4):700–6.

    Article  CAS  PubMed  Google Scholar 

  • Muizelaar JP, Wei EP, Kontos HA, Becker DP. Cerebral blood flow is regulated by changes in blood pressure and in blood viscosity alike. Stroke. 1986;17(1):44–8.

    Article  CAS  PubMed  Google Scholar 

  • Muizelaar JP, Marmarou A, Ward JD, Kontos HA, Choi SC, Becker DP, Gruemer H, Young HF. Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg. 1991;75(5):731–9.

    Article  CAS  PubMed  Google Scholar 

  • Narayan V, Mohammed N, Savardekar AR, et al. Noninvasive intracranial pressure monitoring for severe traumatic brain injury in children: a concise update on current methods. World Neurosurg. 2018;114:293–300.

    Article  PubMed  Google Scholar 

  • Nelson PB, Seif SM, Maroon JC, Robinson AG. Hyponatremia in intracranial disease: perhaps not the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). J Neurosurg. 1981;55(6):938–41.

    Article  CAS  PubMed  Google Scholar 

  • Ng I, Lim J, Wong HB. Effects of head posture on cerebral hemodynamics: its influences on intracranial pressure, cerebral perfusion pressure, and cerebral oxygenation. Neurosurgery. 2004;54(3):593–7; discussion 598.

    Article  PubMed  Google Scholar 

  • Oiso Y, Robertson GL, Norgaard JP, Juul KV. Clinical review: treatment of neurohypophyseal diabetes insipidus. J Clin Endocrinol Metab. 2013;98(10):3958–67.

    Article  CAS  PubMed  Google Scholar 

  • Ooi HL, Maguire AM, Ambler GR. Desmopressin administration in children with central diabetes insipidus: a retrospective review. J Pediatr Endocrinol Metab. 2013;26(11–12):1047–52.

    CAS  PubMed  Google Scholar 

  • Padayachy LC, Figaji AA, Bullock MR. Intracranial pressure monitoring for traumatic brain injury in the modern era. Childs Nerv Syst. 2010;26(4):441–52.

    Article  PubMed  Google Scholar 

  • Padayachy LC, Rohlwink U, Zwane E, Fieggen G, Peter JC, Figaji AA. The frequency of cerebral ischemia/hypoxia in pediatric severe traumatic brain injury. Childs Nerv Syst. 2012;28(11):1911–8.

    Article  PubMed  Google Scholar 

  • Palmer BF. Hyponatremia in patients with central nervous system disease: SIADH versus CSW. Trends Endocrinol Metab. 2003;14(4):182–7.

    Article  CAS  PubMed  Google Scholar 

  • Perry JJ, Lee JS, Sillberg VA, Wells GA. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2008;16(2):CD002788.

    Google Scholar 

  • Peterson B, Khanna S, Fisher B, Marshall L. Prolonged hypernatremia controls elevated intracranial pressure in head-injured pediatric patients. Crit Care Med. 2000;28(4):1136–43.

    Article  CAS  PubMed  Google Scholar 

  • Pfenninger J, Santi A. Severe traumatic brain injury in children – are the results improving? Swiss Med Wkly. 2002;132(9–10):116–20.

    PubMed  Google Scholar 

  • Pinto PS, Poretti A, Meoded A, Tekes A, Huisman TA. The unique features of traumatic brain injury in children. Review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications and their imaging findings – part 1. J Neuroimaging. 2012;22(2):e1–e17.

    Article  PubMed  Google Scholar 

  • Pittman T, Bucholz R, Williams D. Efficacy of barbiturates in the treatment of resistant intracranial hypertension in severely head-injured children. Pediatr Neurosci. 1989;15(1):13–7.

    Article  CAS  PubMed  Google Scholar 

  • Psarras K, Lalountas MA, Symeonidis NG, Baltatzis M, Pavlidis ET, Ballas K, Pavlidis TE, Sakantamis AK. Inadvertent insertion of a nasogastric tube into the brain: case report and review of the literature. Clin Imaging. 2012;36(5):587–90.

    Article  PubMed  Google Scholar 

  • Qureshi AI, Suarez JI. Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Crit Care Med. 2000;28(9):3301–13.

    Article  CAS  PubMed  Google Scholar 

  • Rohlwink UK, Zwane E, Fieggen AG, Argent AC, le Roux PD, Figaji AA. The relationship between intracranial pressure and brain oxygenation in children with severe traumatic brain injury. Neurosurgery. 2012;70(5):1220–30; discussion 1231.

    Article  PubMed  Google Scholar 

  • Rose SR, Auble BA. Endocrine changes after pediatric traumatic brain injury. Pituitary. 2012;15(3):267–75.

    Article  CAS  PubMed  Google Scholar 

  • Sandestig A, Romner B, Grande PO. Therapeutic hypothermia in children and adults with severe traumatic brain injury. Ther Hypothermia Temp Manag. 2014;4(1):10–20.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schierhout G, Roberts I. Mannitol for acute traumatic brain injury. Cochrane Database Syst Rev. 2000;(2):CD001049.

    Google Scholar 

  • Schoon P, Benito Mori L, Orlandi G, Larralde C, Radrizzani M. Incidence of intracranial hypertension related to jugular bulb oxygen saturation disturbances in severe traumatic brain injury patients. Acta Neurochir Suppl. 2002;81:285–7.

    CAS  PubMed  Google Scholar 

  • Schulte am Esch J, Pfeifer G, Thiemig I, Entzian W. The influence of intravenous anaesthetic agents on primarily increased intracranial pressure. Acta Neurochir. 1978;45(1–2):15–25.

    Article  CAS  PubMed  Google Scholar 

  • Seyed Saadat SM, Bidabadi E, Seyed Saadat SN, Mashouf M, Salamat F, Yousefzadeh S. Association of persistent hyperglycemia with outcome of severe traumatic brain injury in pediatric population. Childs Nerv Syst. 2012;28(10):1773–7.

    Article  PubMed  Google Scholar 

  • Shapiro K, Marmarou A. Clinical applications of the pressure-volume index in treatment of pediatric head injuries. J Neurosurg. 1982;56(6):819–25.

    Article  CAS  PubMed  Google Scholar 

  • Sharples PM, Stuart AG, Matthews DS, Aynsley-Green A, Eyre JA. Cerebral blood flow and metabolism in children with severe head injury. Part 1: relation to age, Glasgow Coma Score, outcome, intracranial pressure, and time after injury. J Neurol Neurosurg Psychiatry. 1995;58(2):145–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Shore PM, Thomas NJ, Clark RS, Adelson PD, Wisniewski SR, Janesko KL, Bayir H, Jackson EK, Kochanek PM. Continuous versus intermittent cerebrospinal fluid drainage after severe traumatic brain injury in children: effect on biochemical markers. J Neurotrauma. 2004;21(9):1113–22.

    Article  PubMed  Google Scholar 

  • Skippen P, Seear M, Poskitt K, Kestle J, Cochrane D, Annich G, Handel J. Effect of hyperventilation on regional cerebral blood flow in head-injured children. Crit Care Med. 1997;25(8):1402–9.

    Article  CAS  PubMed  Google Scholar 

  • Tabori U, Kornecki A, Sofer S, Constantini S, Paret G, Beck R, Sivan Y. Repeat computed tomographic scan within 24–48 hours of admission in children with moderate and severe head trauma. Crit Care Med. 2000;28(3):840–4.

    Article  CAS  PubMed  Google Scholar 

  • The Brain Trauma Foundation, The American Association of Neurological Surgeons, The Joint Section on Neurotrauma and Critical Care. Use of mannitol. J Neurotrauma. 2000;17(6–7):521–5.

    Google Scholar 

  • Tobias JD. Airway management in the pediatric trauma patient. J Intensive Care Med. 1998;13:1–14.

    Article  Google Scholar 

  • Turcant A, Delhumeau A, Premel-Cabic A, Granry JC, Cottineau C, Six P, Allain P. Thiopental pharmacokinetics under conditions of long-term infusion. Anesthesiology. 1985;63(1):50–4.

    Article  CAS  PubMed  Google Scholar 

  • van den Brink WA, van Santbrink H, Steyerberg EW, Avezaat CJ, Suazo JA, Hogesteeger C, Jansen WJ, Kloos LM, Vermeulen J, Maas AI. Brain oxygen tension in severe head injury. Neurosurgery. 2000;46(4):868–76; discussion 876–868.

    PubMed  Google Scholar 

  • Vavilala MS, Lee LA, Lam AM. The lower limit of cerebral autoregulation in children during sevoflurane anesthesia. J Neurosurg Anesthesiol. 2003;15(4):307–12.

    Article  PubMed  Google Scholar 

  • Vespa P, Bergsneider M, Hattori N, Wu HM, Huang SC, Martin NA, Glenn TC, McArthur DL, Hovda DA. Metabolic crisis without brain ischemia is common after traumatic brain injury: a combined microdialysis and positron emission tomography study. J Cereb Blood Flow Metab. 2005;25(6):763–74.

    Article  CAS  PubMed  Google Scholar 

  • Wahlstrom MR, Olivecrona M, Koskinen LO, Rydenhag B, Naredi S. Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy – the Lund concept. Intensive Care Med. 2005;31(6):832–9.

    Article  PubMed  Google Scholar 

  • Weed L, McKibben P. Pressure changes in cerebrospinal fluid following intravenous injection of solutions of various concentrations. Am J Phys. 1919;48:512–30.

    Article  Google Scholar 

  • Werner C, Engelhard K. Pathophysiology of traumatic brain injury. Br J Anaesth. 2007;99(1):4–9.

    Article  CAS  PubMed  Google Scholar 

  • White JR, Farukhi Z, Bull C, Christensen J, Gordon T, Paidas C, Nichols DG. Predictors of outcome in severely head-injured children. Crit Care Med. 2001;29(3):534–40.

    Article  CAS  PubMed  Google Scholar 

  • Williams EL, Hildebrand KL, McCormick SA, Bedel MJ. The effect of intravenous lactated Ringer’s solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers. Anesth Analg. 1999;88(5):999–1003.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Intensive Care Unit, Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria

    Christoph Castellani

  2. Department of Neurosurgery, Medical University of Graz, Graz, Austria

    Hans-Georg Eder

Authors
  1. Christoph Castellani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hans-Georg Eder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph Castellani .

Editor information

Editors and Affiliations

  1. Our Lady’s Children's Hospital, National Children’s Research Centre, Dublin, Ireland

    Prem Puri

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer-Verlag GmbH Germany, part of Springer Nature

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Castellani, C., Eder, HG. (2020). Conservative Management of Severe Cerebral Trauma. In: Puri, P. (eds) Pediatric Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38482-0_200-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-38482-0_200-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-38482-0

  • Online ISBN: 978-3-642-38482-0

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation