Professional Documents
Culture Documents
Alarming Statistics
TBI: leading cause of death and disability in
children
- in US:
US 79// 100000 admission for head injury,
j y,
chidren: 200000 head injury /year: 10%
severe TBI
National Centers for Injury Prevention and Control.
- in KSA:
KSA NGH: 1598 admissions :664MVA: 378: TBI:
24% severe TBI: 30 died
Crankson SJ; motor vehicle injuries in childhood: a hospital-based
study in Saudi Arabia, Pediatr Surg Int 2006
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Objectives
Pathoph siolog
Pathophysiology
Neuromonitoring
Therapy
Biomarkers
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Pathoph siolog
Pathophysiology
Neuromonitoring
Therapy
Biomarkers
Optimal CPP
Guidelines.
Guidelines
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Pathoph siolog
Pathophysiology
Neuromonitoring
Th
Therapy
Biomarkers
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ICP monitoring
Recommendation:
ICP monitoring :
WHY ?
- Strong evidence supports the association of Increased ICP
and poor neurological outcome
- ICP monitoring and aggressive treatment of increased ICP
are associated with the best reported clinical outcome
- guideline level in the adult literature
When ?
- GCS≤ 8 - with abnormal CT scan
- hemodynamic instability
- GCS 8 patient sedated or on neuromuscular blockade.
How ?
- intraventricular ICP
- intraparenchymal ICP….
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Aim:
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TCD « goal
goal-- directed therapy »
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Detection of convulsion:
High incidence of post traumatic non non-
convulsive seizure in adult TBI/ increased
ICP and interstitial Lactate/pyruvate
EEG
Prognostic value in patient with disorder of
consciousness post TBI.
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Pathoph siolog
Pathophysiology
Neuromonitoring
Therapy
Biomarkers
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Recommendations
Option.
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Recommendations
Options.
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Decompressive craniectomy
Indications:
Diffuse cerebral swelling on CT brain
Within 48hrs of injury
No episodes of sustained ICP>40mmHg
GCS>3 at some point subsequent to
injury
Secondary clinical deterioration
Evolving cerebral herniation
Decompressive craniectomy
As Rescue therapy:
therapy
Jagannathan J et al. Outcome following decompressive
craniectomy in children with severe TBI: a10-year single center experience with
long term follow up. J Neurosurg 2007
As Early intervention:
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Recommendations
Options.
- Extrapolated from the adult data, hyperthermia
should be avoided in children with severe TBI
Mechanisms of action
Antioxidant effect
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Hutchison
H t hi J ett al.
l HyP-HIT
H P HIT Investigators
I ti t anad
d canadian
di critical
iti l care trial
ti l
group. Hypothermia therapy after TBI in children. N.Engl.j.Med.2008
Anti--seizure Prophylaxis
Anti
Recommendations:
Guidelines.
Prophylactic anti-seizure therapy may be
considered to prevent early PTS in pediatric patient
Options.
Prophylactic use of anti-seizure therapy is not
recommended for children with severe TBI for
preventing late PTS
Indications from adult guidelines
Use of phenytoin has been shown to decrease the
risk of early PTS. There is no evidence that outcome
is improved.
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Pathoph siolog
Pathophysiology
Neuromonitoring
Therapy
Biomarkers
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Serum biomarker:
- Adjunct to clinical examination in case of
inflicted trauma
- Prognostic
g factors
Bergers et al Serum biomarker concentrations and
outcome after pediatric traumatic brain injury. J Neurotrauma. 2007
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Dash KP. Biomarkers for the Diagnosis, Prognosis, and Evaluation of Treatment
Efficacy for Traumatic Brain Injury. Neurotherapeutics 2010
Dash KP. Biomarkers for the Diagnosis, Prognosis, and Evaluation of Treatment
Efficacy for Traumatic Brain Injury. Neurotherapeutics 2010
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Primary prophylaxis
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