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Notfall + Rettungsmedizin

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01.03.2009 | Pädiatrische Notfälle

Schweres Schädel-Hirn-Trauma

Monitoring und Management beim Kind

verfasst von: PD Dr. B. Wagner

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 2/2009

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Zusammenfassung

Die Fachliteratur beschreibt eine hohe Variabilität bezüglich Mortalität und Morbidität des schweren Schädel-Hirn-Traumas im Kindesalter, welche das Ausarbeiten effektiver Überwachungs- und Behandlungsstrategien erschwert. Nichtsdestotrotz weist die sorgfältige Evaluation der Evidenzlage darauf hin, dass durch neurointensivmedizinisches Monitoring und Einhalten gewisser Zielwerte für den intrakraniellen Druck, den zerebralen Perfusionsdruck, die venöse Sauerstoffsättigung im Bulbus jugularis (S_jvO₂) und den Sauerstoffpartialdruck im Hirngewebe (p_brO₂) sowie für die Hirntemperatur das Outcome verbessert werden kann. Gleiches gilt für den Einsatz von Therapien ohne zerebrales Ischämierisiko wie hypertone Kochsalzlösung, Mannitol, Liquordrainage und Dekompressionskraniektomie. Ebenso scheint die Steuerung des intrakraniellen Drucks mithilfe einer Blutdruckerhöhung bei intakter Autoregulation bzw. Blutdrucksenkung bei gestörter Autoregulation von Nutzen zu sein. Diese Prinzipien gelten entlang der ganzen Versorgungskette des traumatisierten Kindes.

Vorheriger Artikel Atemwegsmanagement mit dem LTS-D während der Reanimation

Nächster Artikel Elzacher Notfalltag für Medizinstudierende der Universität Freiburg

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Brinker M den, Hokken-Koelega A, Hazelzet J et al. (2007) One single dose of etomidate negatively influences adrenocortical performance for at least 24 h in children with meningococcal sepsis. Intensive Care Med 21: Epub ahead of print

Caricato A, Conti G, Corte F et al. (2005) Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: The role of respiratory system compliance. J Trauma 58: 571–576PubMedCrossRef

Carney N, Chesnut R, Kochanek P (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Pediatr Crit Care Med 4: S1–S75PubMedCrossRef

Chambers I, Jones P, Lo T et al. (2006) Critical thresholds of intracranial pressure and cerebral perfusion pressure related to age in paediatric head injury. J Neurol Neurosurg Psychiatry 77: 234–240PubMedCrossRef

Chambers I, Treadwell L, Mendelow A (2001) Determination of threshold levels of cerebral perfusion pressure and intracranial pressure in severe head injury by using receiver-operating characteristic curves: an observational study in 291 patients. J Neurosurg 94: 412–416PubMedCrossRef

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Cruz J, Nakayama P, Imamura J et al. (2002) Cerebral extraction of oxygen and intracranial hypertension in severe, acute, pediatric brain trauma: preliminary novel management strategies. Neurosurgery 50: 774–779PubMedCrossRef

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Downard C, Hulka F, Mullins R et al. (2000) Relationship of cerebral perfusion pressure and survival in pediatric brain-injured patients. J Trauma 49: 654–659PubMedCrossRef

11.

Doyle J, Davis D, Hoyt D (2001) The use of hypertonic saline in the treatment of traumatic brain injury. J Trauma 50: 367–383PubMedCrossRef

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Gopinath S, Valadka A, Uzura M, Robertson C (1999) Comparison of jugular venous oxygen saturation and brain tissue Po2 as monitors of cerebral ischemia after head injury. Crit Care Med 27: 2337–2345PubMedCrossRef

13.

Grände P (2006) The „Lund Concept“ for the treatment of severe head trauma–physiological principles and clinical application. Intensive Care Med 32: 1475–1484PubMedCrossRef

14.

Howells T, Elf K, Jones P et al. (2005) Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma. J Neurosurg 102: 311–317PubMedCrossRef

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Imberti R, Bellinzona G, Langer M (2002) Cerebral tissue PO2 and SjvO2 changes during moderate hyperventilation in patients with severe traumatic brain injury. J Neurosurg 96: 97–102PubMedCrossRef

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Jeremitsky E, Omert L, Dunham C et al. (2003) Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion. J Trauma 54: 312–319PubMedCrossRef

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Jiang J, Xu W, Li W et al. (2006) Effect of long-term mild hypothermia or short-term mild hypothermia on outcome of patients with severe traumatic brain injury. J Cereb Blood Flow Metab 26: 771–776PubMedCrossRef

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Munch E, Bauhuf C, Horn P et al. (2001) Therapy of malignant intracranial hypertension by controlled lumbar cerebrospinal fluid drainage. Crit Care Med 29: 976–981PubMedCrossRef

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Oertel M, Kelly D, Lee J et al. (2002) Efficacy of hyperventilation, blood pressure elevation, and metabolic suppression therapy in controlling intracranial pressure after head injury. J Neurosurg 97: 1045–1053PubMedCrossRef

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Perez A, Minces P, Schnitzler E et al. (2003) Jugular venous oxygen saturation or arteriovenous difference of lactate content and outcome in children with severe traumatic brain injury. Pediatr Crit Care Med 4: 33–38PubMedCrossRef

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Stocchetti N, Protti A, Lattuada M et al. (2005) Impact of pyrexia on neurochemistry and cerebral oxygenation after acute brain injury. J Neurol Neurosurg Psychiatry 76: 1135–1139PubMedCrossRef

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Titel: Schweres Schädel-Hirn-Trauma
Monitoring und Management beim Kind
verfasst von: PD Dr. B. Wagner
Publikationsdatum: 01.03.2009
Verlag: Springer-Verlag
Erschienen in: Notfall + Rettungsmedizin / Ausgabe 2/2009
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI: https://doi.org/10.1007/s10049-007-0980-x

Springerpflege

Zusammenfassung

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