Morris Kevin P, Forsyth Robert J, Parslow Roger C, Tasker Robert C, Hawley Carol A
Diana Princess of Wales Children's Hospital, Steelhouse Lane, B4 6NH, Birmingham, UK.
Intensive Care Med. 2006 Oct;32(10):1606-12. doi: 10.1007/s00134-006-0285-4. Epub 2006 Jul 28.
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.
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.
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. Intra-ventricular 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.
There is an urgent need for greater standardisation of practice across UK centres admitting children with severe TBI.
确定与颅内压（ICP）监测使用相关的因素，并明确英国重度创伤性脑损伤（TBI）患儿正在使用哪些以ICP为目标的治疗方法。对照最近发布的指南评估当前的治疗实践。
对2001年2月至2003年8月期间英国和爱尔兰收治TBI患儿（<16岁）的儿科和成人重症监护病房的临床和人口统计学信息进行前瞻性数据收集。
获取了501名儿童的详细临床信息，其中445名有关于ICP监测使用的信息。在急诊室格拉斯哥昏迷量表评分为8分或以下的患儿中，仅59%（75/127）使用了ICP监测。在ICP监测的使用方面，各中心之间存在很大差异，与损伤严重程度无关。有86名儿童在未进行ICP监测的情况下接受了以ICP为目标的治疗。在以ICP为目标的治疗的使用以及管理的一般方面，如液体限制、肌肉松弛剂和预防性抗惊厥药物的使用方面，各中心之间存在很大差异。很少放置脑室内导管（6%的病例）；因此，脑脊液引流很少用作ICP升高的一线治疗方法。目前的实践中很少使用颈静脉球血氧饱和度测定法（4%）、脑微透析（<1%）和脑组织氧监测（<1%）。与已发布的指南相反，在未监测脑缺血的情况下使用了中度至重度过度通气。
对于收治重度TBI患儿的英国各中心，迫切需要在治疗实践上实现更大程度的标准化。
