Critical care of children with acute brain injury

Severe neurologic illness and injury in children may occur in a wide range of clinical and environmental settings. The majority of children who sustain traumatic brain injury will achieve a good outcome if intensive care is directed toward preventing secondary injury. The most important aspect of care is ensuring adequate oxygenation, ventilation, and perfusion. Together with standard supportive care, the aggressive use of intraventricular pressure monitoring and CSF drainage to treat intracranial hypertension can attenuate or prevent continuing brain injury. Sustained hyperventilation, aggressive diuresis, hypothermia, and induction of barbiturate coma are reserved for children for whom the first tier of therapy is not effective.