Department of Critical Care Medicine, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
Department of Neurology and Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA.
Pediatr Crit Care Med. 2019 Mar;20(3):269-279. doi: 10.1097/PCC.0000000000001737.
To produce a treatment algorithm for the ICU management of infants, children, and adolescents with severe traumatic brain injury.
Studies included in the 2019 Guidelines for the Management of Pediatric Severe Traumatic Brain Injury (Glasgow Coma Scale score ≤ 8), consensus when evidence was insufficient to formulate a fully evidence-based approach, and selected protocols from included studies.
Baseline care germane to all pediatric patients with severe traumatic brain injury along with two tiers of therapy were formulated. An approach to emergent management of the crisis scenario of cerebral herniation was also included. The first tier of therapy focuses on three therapeutic targets, namely preventing and/or treating intracranial hypertension, optimizing cerebral perfusion pressure, and optimizing partial pressure of brain tissue oxygen (when monitored). The second tier of therapy focuses on decompressive craniectomy surgery, barbiturate infusion, late application of hypothermia, induced hyperventilation, and hyperosmolar therapies.
This article provides an algorithm of clinical practice for the bedside practitioner based on the available evidence, treatment protocols described in the articles included in the 2019 guidelines, and consensus that reflects a logical approach to mitigate intracranial hypertension, optimize cerebral perfusion, and improve outcomes in the setting of pediatric severe traumatic brain injury.
制定 ICU 中严重创伤性脑损伤婴幼儿和青少年的治疗方案。
纳入 2019 年《儿童严重创伤性脑损伤管理指南》（格拉斯哥昏迷评分≤8 分）的研究、证据不足无法制定完全基于证据的方法时的共识，以及纳入研究中的选定方案。
为所有严重创伤性脑损伤的儿科患者制定了与基线护理相关的内容，以及两个级别的治疗方案。还包括针对脑疝危机情况的紧急处理方法。一级治疗侧重于三个治疗目标，即预防和/或治疗颅内高压、优化脑灌注压以及优化脑组织氧分压（当监测时）。二级治疗侧重于去骨瓣减压术、巴比妥输注、低温后应用、诱导性过度通气和高渗治疗。
本文基于现有证据、纳入 2019 年指南的文章中描述的治疗方案以及共识，为床边医生提供了一种临床实践算法，该算法反映了一种减轻颅内高压、优化脑灌注和改善儿童严重创伤性脑损伤患者预后的合理方法。
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