Management of severe traumatic brain injury in pediatric patients: an evidence-based approach

期刊论文
发表日期：

2024年10月30日

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Ana Paula de Carvalho Panzeri Carlotti,
Vivian Henriques do Amaral,
Ana Paula de Carvalho Canela Balzi,
Cintia Johnston,
Fabiane Allioti Regalio,
Maíra Freire Cardoso,
Juliana Ferreira Ferranti,
Patrícia Zamberlan,
Alfredo Elias Gilio,
Luiz Marcelo Sá Malbouisson,
Artur Figueiredo Delgado,
Werther Brunow de Carvalho,
Ana Lúcia Capelari Lahoz,
Michele Luglio,
Maria Lucia Barbosa Maia dos Santos,
Patricia Freitas Góes,
Saul Almeida da Silva,
Wellingson Silva Paiva,
Alexandre Peixoto Serafim,
Leonardo Calil Vicente Franco de Souza,
Sandra Lange Zaponi Melek

摘要

Background

Traumatic brain injury (TBI) is a major cause of death and disability worldwide. The decision-making process in the management of severe TBI must be based on the best available evidence to minimize the occurrence of secondary brain injuries. However, healthcare approaches to managing TBI patients exhibit considerable variation.

Methods

Over an 18-month period, a multidisciplinary panel consisting of medical doctors, physiotherapists, nutritional therapists, and nurses performed a comprehensive review on various subtopics concerning TBI. The panel identified primary questions to be addressed using the Population, Intervention, Control, and Outcome (PICO) format and applied the Evidence to Decision (EtD) framework criteria for evaluating interventions. Subsequently, the panel formulated recommendations for the management of severe TBI in children.

Results

Fourteen evidence-based recommendations have been devised for the management of severe TBI in children, covering nine topics, including imaging studies, neuromonitoring, prophylactic anticonvulsant use, hyperosmolar therapy, sedation and analgesia, mechanical ventilation strategies, nutritional therapy, blood transfusion, and decompressive craniectomy. For each topic, the panel provided clinical recommendations and identified research priorities.

Conclusions

This review offers evidence-based strategies aimed to guide practitioners in the care of children who suffer from severe TBI.