Traumatic brain injury in the paediatric population

Paediatric trauma is the leading cause of death in children more than 1 year. Traumatic brain injury (TBI) makes up a significant contribution to overall mortality.This paper reviews current and historical evidence for the way these patients are managed. It reflects on the pathophysiological insult and the proposed physiological mechanisms by which the brain responds. Using an illustrative case, we look at the intensive care phase of management.It looks at the basic and advanced medical and surgical interventions commonly employed on paediatric intensive care. In particular it focuses on intracranial pressure monitoring and management as well as the choice of cerebral perfusion pressure targeting and its control. It also questions whether these modalities are the best way to monitor the patient with TBI with regards to outcome. Finally it looks at cerebrovascular pressure reactivity index as a potential advance in care as part of a multi-modal monitoring package.