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Pediatric neurocritical care

Christopher Markham, Enola K Proctor, Jose A Pineda
PURPOSE OF REVIEW: Brain-directed critical care for children is a relatively new area of subspecialization in pediatric critical care. Pediatric neurocritical care teams combine the expertise of neurology, neurosurgery, and critical care medicine. The positive impact of delivering specialized care to pediatric patients with acute neurological illness is becoming more apparent, but the optimum way to implement and sustain the delivery of this is complicated and poorly understood. We aim to provide emerging evidence supporting that effective implementation of pediatric neurocritical care pathways can improve patient survival and outcomes...
March 30, 2017: Current Opinion in Pediatrics
Andrew J Prout, Michael S Wolf, Ericka L Fink
PURPOSE OF REVIEW: Traumatic brain injury (TBI) and cardiac arrest are important causes of morbidity and mortality in children. Improved diagnosis and outcome prognostication using validated biomarkers could allow clinicians to better tailor therapies for optimal efficacy. RECENT FINDINGS: Contemporary investigation has yielded plentiful biomarker candidates of central nervous system (CNS) injury, including macromolecules, genetic, inflammatory, oxidative, and metabolic biomarkers...
March 17, 2017: Current Opinion in Pediatrics
Ericka L Fink, Patrick M Kochanek, Robert C Tasker, John Beca, Michael J Bell, Robert S B Clark, Jamie Hutchison, Monica S Vavilala, Anthony Fabio, Derek C Angus, R Scott Watson
OBJECTIVE: The international scope of critical neurologic insults in children is unknown. Our objective was to assess the prevalence and outcomes of children admitted to PICUs with acute neurologic insults. DESIGN: Prospective study. SETTING: Multicenter (n = 107 PICUs) and multinational (23 countries, 79% in North America and Europe). PATIENTS: Children 7 days to 17 years old admitted to the ICU with new traumatic brain injury, stroke, cardiac arrest, CNS infection or inflammation, status epilepticus, spinal cord injury, hydrocephalus, or brain mass...
April 2017: Pediatric Critical Care Medicine
Christopher M Horvat, Haifa Mtaweh, Michael J Bell
Pediatric neurocritical care is a growing subspecialty of pediatric intensive care that focuses on the management of acute neurological diseases in children. A brief history of the field of pediatric neurocritical care is provided. Neuromonitoring strategies for children are reviewed. Management of major categories of acute childhood central neurologic diseases are reviewed, including treatment of diseases associated with intracranial hypertension, seizures and status epilepticus, stroke, central nervous system infection and inflammation, and hypoxic-ischemic injury...
December 2016: Seminars in Neurology
Javier Gelvez, Traci Brooks, Candace Wilson, Abel Biesman, Linda Thompson
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
Christopher D Smyser, Emily W Y Tam, Taeun Chang, Janet S Soul, Steven P Miller, Hannah C Glass
BACKGROUND: Neonatal neurocritical care is a growing and rapidly evolving medical subspecialty, with increasing numbers of dedicated multidisciplinary clinical, educational, and research programs established at academic institutions. The growth of these programs has provided trainees in neurology, neonatology, and pediatrics with increased exposure to the field, sparking interest in dedicated fellowship training in fetal-neonatal neurology. OBJECTIVES: To meet this rising demand, increasing numbers of training programs are being established to provide trainees with the requisite knowledge and skills to independently deliver care for infants with neurological injury or impairment from the fetal care center and neonatal intensive care unit to the outpatient clinic...
October 2016: Pediatric Neurology
Susan Peloquin, Annette Carley, Sonia L Bonifacio, Hannah C Glass
Neonatal neurocritical care is an emerging subspecialty that combines the expertise of critical care medicine and neurology with that of nursing and other providers in an interprofessional team approach to care. Neurocritical care of the neonate has roots in adult and pediatric practice. It has been demonstrated that adults with acute neurologic conditions who are treated in a specialized neurocritical care unit have reduced morbidity and mortality, as well as decreased length of stay, lower costs, and reduced need for neurosurgical procedures...
2016: Neonatal Network: NN
Mark S Wainwright, Gregory Hansen, Juan Piantino
PURPOSE OF REVIEW: Approximately one in five children admitted to a pediatric ICU have a new central nervous system injury or a neurological complication of their critical illness. The spectrum of neurologic insults in children is diverse and clinical practice is largely empirical, as few randomized, controlled trials have been reported. This lack of data poses a substantial challenge to the practice of pediatric neurocritical care (PNCC). PNCC has emerged as a novel subspecialty, and its presence is expanding within tertiary care centers...
April 2016: Current Opinion in Critical Care
Kerri L LaRovere, Nicole F O'Brien
Transcranial Doppler sonography is a noninvasive, real-time physiologic monitor that can detect altered cerebral hemodynamics during catastrophic brain injury. Recent data suggest that transcranial Doppler sonography may provide important information about cerebrovascular hemodynamics in children with traumatic brain injury, intracranial hypertension, vasospasm, stroke, cerebrovascular disorders, central nervous system infections, and brain death. Information derived from transcranial Doppler sonography in these disorders may elucidate underlying pathophysiologic characteristics, predict outcomes, monitor responses to treatment, and prompt a change in management...
December 2015: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Sandra D W Buttram, Alicia K Au, Joshua Koch, Karen Lidsky, Kristin McBain, Nicole O'Brien, Brandon A Zielinski, Michael J Bell
Pediatric refractory status epilepticus (RSE) is a neurological emergency with significant morbidity and mortality, which lacks consensus regarding diagnosis and treatment(s). Therapeutic hypothermia (TH) is an effective treatment for RSE in preclinical models and small series. In addition, TH is a standard care for adults after cardiac arrest and neonates with hypoxic-ischemic encephalopathy. The purpose of this study was to identify the feasibility of a study of pediatric RSE within a research group (Pediatric Neurocritical Care Research Group [PNCRG])...
December 2015: Therapeutic Hypothermia and Temperature Management
Sarah Wahlster, Eelco F M Wijdicks, Pratik V Patel, David M Greer, J Claude Hemphill, Marco Carone, Farrah J Mateen
OBJECTIVE: To assess the practices and perceptions of brain death determination worldwide and analyze the extent and nature of variations among countries. METHODS: An electronic survey was distributed globally to physicians with expertise in neurocritical care, neurology, or related disciplines who would encounter patients at risk of brain death. RESULTS: Most countries (n = 91, response rate 76%) reported a legal provision (n = 63, 70%) and an institutional protocol (n = 70, 77%) for brain death...
May 5, 2015: Neurology
James J Riviello, Cherylee Chang
Pediatric neurocritical care (NCC) has emerged as a defined subspecialty in child neurology and requires a collaborative effort among child neurologists, pediatric critical care medicine specialists, and pediatric neurosurgeons. Pediatric NCC has evolved differently in children than in adults, and its delivery depends on the local resources available for pediatric care. This article reviews the current practice of pediatric NCC by child neurologists: where it is practiced, how it is practiced, the disorders encountered (that differ from adult NCC), the training required to care for these disorders, and what is needed for the future of pediatric NCC...
December 2014: Seminars in Pediatric Neurology
Angela Lumba-Brown, Jose Pineda
Pediatric traumatic brain injury accounts for approximately 474,000 emergency department visits, 37,000 hospitalizations, and 3,000 deaths in children 14 years and younger annually in the United States. Acute neurocritical care in children has advanced with specialized pediatric trauma centers and emergency medical services. This article reviews pediatric-specific diagnosis, management, and medical decision making related to the neurocritical care of severe traumatic brain injury.
December 2014: Seminars in Pediatric Neurology
Robert C Tasker
Protecting the brain in vulnerable infants and children with critical illness involving the brain is a central aspect of pediatric intensive care and neurocritical care. Collectively, illness-induced derangements in intracranial pressure, circulatory homeostasis, and pressure autoregulation are all fundamental in informing bedside management. Therefore, this review provides an understanding of these entities and a physiological approach to bedside care and monitoring.
December 2014: Seminars in Pediatric Neurology
Mark S Wainwright, Michele Grimason, Joshua Goldstein, Craig M Smith, Catherine Amlie-Lefond, Gadi Revivo, Zehava L Noah, Zena L Harris, Leon G Epstein
We describe our 10-year experience developing the Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program at Northwestern University Feinberg School of Medicine. The neurocritical care team includes intensivists, neurologists, and an advanced practice nurse who have expertise in critical care neurology and who continue care in long-term follow-up of intensive care unit patients in a dedicated neurocritical care outpatient clinic. Brain-directed critical care requires collaboration between intensivists and neurologists with specific expertise in neurocritical care, using protocol-directed consistent care, and physiological measures to protect brain function...
December 2014: Seminars in Pediatric Neurology
Raquel Farias-Moeller, Jessica L Carpenter, Nathan Dean, Elizabeth M Wells
BACKGROUND: Autonomic dysfunction in pediatric patients with acquired brain injury is often encountered and greatly understudied. We sought to identify the incidence of Paroxysmal Sympathetic Hyperactivity (PSH) in critically ill pediatric patients with meningoencephalitis and encephalitis, associated risk factors and influence on outcome. METHODS: Children admitted to the pediatric intensive care unit (PICU) with a diagnosis of meningoencephalitis and/or encephalitis were identified from a single institution Neurocritical Care database...
December 2015: Neurocritical Care
Sarah A Murphy, Michael J Bell, Maureen E Clark, Michael J Whalen, Natan Noviski
BACKGROUND: Although attention to neurologic injuries and illnesses in pediatric critical care is not new, a sub-specialized field of pediatric neurocritical care has only recently been recognized. Pediatric neurocritical care is an emerging area of clinical and investigative focus. Little is known about the prevalence of specialized pediatric neurocritical care services nor about perceptions regarding how it is impacting medical practice. This survey sought to capture perceptions about an emerging area of specialized pediatric neurocritical care among practitioners in intersecting disciplines, including pediatric intensivists, pediatric neurologits and pediatric neurosurgeons...
October 2015: Neurocritical Care
Soonu Udani
The neurologically injured child, whether from trauma or other causes, is a common admission into any Pediatric critical care unit. Whatever the cause, the risk for death and life long disability remains very high. Unlike the adult population, neurological diseases in children are diverse and arise from a variety of factors that vary greatly in age and presentation. Nervous system dysfunction is often a complication of critical illness and interventions. While neurointensive care units may be ideal for the at-risk child, in mixed units, 40 % of admissions may be neurological or have neurological complications...
March 2015: Indian Journal of Pediatrics
Lyvonne N Tume, Agnes van den Hoogen, Joke M Wielenga, Jos M Latour
OBJECTIVES: To identify and to establish research priorities for pediatric intensive care nursing science across Europe. DESIGN: A modified three-round electronic Delphi technique was applied. Questionnaires were translated into seven different languages. SETTING: European PICUs. PARTICIPANTS: The participants included pediatric intensive care clinical nurses, managers, educators, and researchers. In round 1, the qualitative responses were analyzed by content analysis and a list of research statements and domains was generated...
June 2014: Pediatric Critical Care Medicine
Robert C Tasker
Paralytic poliomyelitis, Reye syndrome, Hemophilus Influenzae type B epiglottitis, bacterial meningitis, and meningococcal septic shock are catastrophic illnesses that in the last 60 years have shaped the development of pediatric intensive care. Neurocritical care has been at the forefront of our thinking and, more latterly, as a specialty we have had the technology and means to develop this focus, educate the next generation and show that outcomes can be improved-first in adult critical care and now the task is to translate these benefits to critically ill children...
July 2014: Paediatric Anaesthesia
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