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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Feb 4, 2016; 5(1): 36-46
Published online Feb 4, 2016. doi: 10.5492/wjccm.v5.i1.36
Neuroprotective measures in children with traumatic brain injury
Shruti Agrawal, Ricardo Garcia Branco
Shruti Agrawal, Ricardo Garcia Branco, Department of Paediatric Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
Author contributions: Agrawal S did the research and drafted the article; Branco RG made critical revisions related to important intellectual content of the manuscript.
Conflict-of-interest statement: Agrawal S and Branco RG have no conflicts of interest to declare for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shruti Agrawal, MD, FRCPCH, FFICM, Department of Paediatric Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Box 7, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom. shruti.agrawal@addenbrookes.nhs.uk
Telephone: +44-1223-348066 Fax: +44-1223-586794
Received: September 29, 2015
Peer-review started: October 2, 2015
First decision: October 27, 2015
Revised: December 1, 2015
Accepted: January 8, 2016
Article in press: January 11, 2016
Published online: February 4, 2016
Processing time: 116 Days and 9.8 Hours
Abstract

Traumatic brain injury (TBI) is a major cause of death and disability in children. Severe TBI is a leading cause of death and often leads to life changing disabilities in survivors. The modern management of severe TBI in children on intensive care unit focuses on preventing secondary brain injury to improve outcome. Standard neuroprotective measures are based on management of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) to optimize the cerebral blood flow and oxygenation, with the intention to avoid and minimise secondary brain injury. In this article, we review the current trends in management of severe TBI in children, detailing the general and specific measures followed to achieve the desired ICP and CPP goals. We discuss the often limited evidence for these therapeutic interventions in children, extrapolation of data from adults, and current recommendation from paediatric guidelines. We also review the recent advances in understanding the intracranial physiology and neuroprotective therapies, the current research focus on advanced and multi-modal neuromonitoring, and potential new therapeutic and prognostic targets.

Keywords: Paediatrics, Intracranial pressure, Traumatic brain injury, Neuroprotection, Paediatric critical care, Advanced neuromonitoring

Core tip: Paediatric traumatic brain injury (TBI) causes significant morbidity and mortality. The modern management of severe TBI in children focuses on preventing secondary brain injury to improve outcome. In this article, we review the current management of severe TBI in children. We also review the recent advances in understanding intracranial physiology and neuroprotective therapies, advanced and multi-modal neuromonitoring, and potential new therapeutic and prognostic targets.