[Continuous monitoring of intracranial pressure and new aspects of neurologic intensive care for children].

A new concept of neurointensive care is presented which is based on earily measured parameters such as intracranial pressure (ICP), mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) (CPP = MAP - ICP). ICP should preferably be measured by a subarachnoid hollow screw (Richmond screw). Of chief importance in neurointensive care (after adequate neurodiagnosis) is the avoidance or treatment of cerebral edema and maintenance of sufficient CPP, which should be above 50 mm Hg in older children. This is achieved by controlled hyperventilation under curare, generous oxygenation, control of body temperature, dexamethasone and possibly barbiturates in very high doses (phenobarbital and thiopentone). This kind of neurointensive care should be administered in all types of severe CNS accidents which are followed by substantial cerebral edema (head injuries, near drowning, Reye's syndrome, hypoxic encephalopathy, encephalitis, meningitis and intracranial bleeding). To obtain the indication for ICP monitoring, the depth of the disturbance of consciousness is measured by the Glasgow Coma Scale. Children with the aforementioned affections and a Glasgow Coma Scale below 6 to 8 should be treated as outlined above. The data published in the literature and our own experience point very much in this direction, especially for severe head injury, Reye's syndrome and near drowning.