The brain in pediatric critical care: unique aspects of assessment, monitoring, investigations, and follow-up

Kate L. Brown*, Shruti Agrawal, Matthew P. Kirschen, Chani Traube, Alexis Topjian, Ronit Pressler, Cecil D. Hahn, Barnaby R. Scholefield, Hari Krishnan Kanthimathinathan, Aparna Hoskote, Felice D’Arco, Melania Bembea, Joseph C. Manning, Maayke Hunfeld, Corinne Buysse, Robert C. Tasker

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

11 Citations (Scopus)

Abstract

As survival after pediatric intensive care unit (PICU) admission has improved over recent years, a key focus now is the reduction of morbidities and optimization of quality of life for survivors. Neurologic disorders and direct brain injuries are the reason for 11–16% of admissions to PICU. In addition, many critically ill children are at heightened risk of brain injury and neurodevelopmental difficulties affecting later life, e.g., complex heart disease and premature birth. Hence, assessment, monitoring and protection of the brain, using fundamental principles of neurocritical care, are crucial to the practice of pediatric intensive care medicine. The assessment of brain function, necessary to direct appropriate care, is uniquely challenging amongst children admitted to the PICU. Challenges in assessment arise in children who are unstable, or pharmacologically sedated and muscle relaxed, or who have premorbid abnormality in development. Moreover, the heterogeneity of diseases and ages in PICU patients, means that high caliber evidence is harder to accrue than in adult practice, nonetheless, great progress has been made over recent years. In this ‘state of the art’ paper about critically ill children, we discuss (1) patient types at risk of brain injury, (2) new standardized clinical assessment tools for age-appropriate, clinical evaluation of brain function, (3) latest evidence related to cranial imaging, non-invasive and invasive monitoring of the brain, (4) the concept of childhood ‘post intensive are syndrome’ and approaches for neurodevelopmental follow-up. Better understanding of these concepts is vital for taking PICU survivorship to the next level.

Original languageEnglish
Pages (from-to)535-547
Number of pages13
JournalIntensive Care Medicine
Volume48
Issue number5
DOIs
Publication statusPublished - May 2022

Bibliographical note

Funding Information:
Research reported in this publication was supported by the National Institute of Health Biomedical Research Center at Great Ormond Street Hospital, London UK and the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number R01NS106292 (Dr. Bembea). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health”.

Publisher Copyright:
© 2022, Springer-Verlag GmbH Germany, part of Springer Nature.

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