Neuromonitoring in Pediatric Neurocritical Care: An Introduction

Excerpt

Pediatric neurocritical care is an emerging specialty that has matured over the last 2 decades [1]. Acute neurologic injury contributes to 25% of pediatric intensive care unit admissions and is associated with increased risk of mortality and long-term morbidity [2‐5]. Disability from acute brain injury is attributed to both the primary injury that occurs at the time of initial presentation and secondary brain injury that occurs in the following hours to days. Much of the longer term morbidity is thought to result from consequences of secondary brain injury [6]. Seizures, cerebral edema, brain tissue hypoxia, and hyperthermia represent a constellation of such insults, and their occurrence may not be well detected through the physical examination when patients are comatose or heavily sedated in the intensive care unit [7]. Additionally, physiologic mechanisms to maintain brain homeostasis, such as cerebrovascular pressure reactivity, may be dysregulated during critical illness, making the brain more vulnerable to secondary insults [8]. For these reasons, methods to monitor for secondary brain injury and the brain’s health overall have the potential to improve the clinical management and functional outcomes of critically ill children [9]. …