RESUMEN
PURPOSE OF REVIEW: Traumatic brain injury is the main cause of childhood disability and death. In this review, we highlight recent original findings and emerging themes from published literature on children with serious traumatic brain injury. RECENT FINDINGS: We focus this review on lessons learned from our recent randomized clinical trial of hypothermia therapy in severe traumatic brain injury in children and on bedside neuromonitoring. We propose that integrating the measurement of biomarkers into clinical care as surrogate endpoints and as potential prognostic markers would allow us to evaluate earlier the effect of injury and clinical care in children after traumatic brain injury. Several methods are now more readily available to monitor cerebral physiology in children. These methods include indices evaluating the integrity of cerebral autoregulation, such as the pressure reactivity index derived from values obtained from intracranial pressure measurements, flow velocity measurements from transcranial Doppler ultrasonography or from cerebral oximetry. Other methods allow the evaluation of coma with the nonlinear analysis of electroencephalography or the evaluation of cerebral metabolism and cell death pathways with biomarkers from serum, cerebral spinal fluid, and cerebral microdialysis. SUMMARY: We suggest expanding clinical functional neuromonitoring to help clinicians understand the burden of exposure to physiological variables and response to therapies during intensive care in order to enhance the management of critically ill children with traumatic brain injury.
Asunto(s)
Lesiones Encefálicas/terapia , Monitoreo Fisiológico/métodos , Sistemas de Atención de Punto , Biomarcadores/metabolismo , Encéfalo/metabolismo , Encéfalo/fisiopatología , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/metabolismo , Circulación Cerebrovascular , Niño , Cuidados Críticos/métodos , Electroencefalografía , Homeostasis , Humanos , Hipotensión/prevención & control , Hipotermia Inducida/métodos , Hipertensión Intracraneal/prevención & control , Manejo de Atención al Paciente/métodos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
OBJECTIVE: This feasibility study aimed to describe and evaluate the effectiveness of a novel chest re-opening paediatric resuscitation scenario training scheme. METHODS: A novel scheme offering training on specialist skills required for post-operative cardiac patients such as chest re-opening and cardiac pacing via simulation was described. A prospective audit of the first 23 consecutive training sessions was conducted to assess the scheme's effectiveness. Parameters assessed included timing of chest re-opening or cardiac pacing orders, and any delays in carrying out these orders. RESULTS: The median time required for the medical team leader to order chest re-opening was 4 min. New medical leaders took significantly longer to order chest re-opening than experienced medical team leaders (P = 0.02, Mann-Whitney U test). The performance of the team-in-training deteriorated with the introduction of new members but was correctable with serial training. CONCLUSIONS: Effective simulation training integrating chest re-opening and cardiac pacing into standard paediatric resuscitation guidelines may be achieved without high fidelity simulation equipment.
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Reanimación Cardiopulmonar/métodos , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Maniquíes , Enseñanza , Humanos , Periodo Posoperatorio , Retención en PsicologíaRESUMEN
OBJECTIVE: This feasibility study aimed to determine the maximum theoretical distance the Edinburgh Paediatric Retrieval Team (EPRT) could travel to retrieve head injured children without additional delay in reaching definitive care. DESIGN: A prospective audit was conducted over 2 years to determine the current practice for paediatric head injury transfers (stabilisation, referral, and transfer time) undertaken by primary hospital staff, and the performance (mobilisation and travel time) of the EPRT. A novel formula was devised and used to determine the theoretical maximum radius within which the EPRT could reach a referring hospital during their stabilisation of head injured patients. MEASUREMENTS AND RESULTS: During the study period, 27 head injured patients were transferred to our unit by road and the EPRT conducted 194 road retrievals. The median stabilisation time for the head injured patients was 3.6 h. Median time to refer these patients to neurosurgical services was 1 h after presenting to primary hospitals. Median mobilisation time for EPRT was 1 h. Using our novel formula, 67 miles was the theoretical maximum radius within which the EPRT could reach a referring hospital during their stabilisation of head injured patients. CONCLUSIONS: Specialist team retrieval of paediatric head injury is a possibility, but not without significant organisational changes such as availability of second teams, early referral of patients and utilisation of the mobilisation time as a cancellation window. Our novel formula offers other teams a starting point to assess their own performance and to develop services.