Introducción: El trauma craneoencefálico (TCE) es un problema de salud mundial que Palabras clave: Trauma craneoencefálico; Lesión primaria; Lesión. Anales de Pediatría Originales. Tratamiento del traumatismo craneoencefálico aislado leve. Estudio multicéntricoManagement of isolated minor head trauma. Manejo Básico del Trauma Craneoencefálico. Cualquier lesión física o deterioro funcional del contenido craneal secundario a un intercambio brusco de . Download . Traumatismo Craneoencefalico en Pediatria.
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Palabras clave: Traumatismo craneoencefálico; neuropsi- cología; secuelas; neuroimagen; evaluación. Title: Neuropsychological sequelae of traumatic brain in-. RECOMENDACIONES DE CUIDADOS DE ENFERMERÍA PARA EL PACIENTE CON TRAUMATISMO CRANEOENCEFÁLICO SEVERO INGRESADO EN LA. Download Citation on ResearchGate | Traumatismo craneoencefálico en niños: Mecanismos de la lesión primaria | Traumatic brain injury results from the.
This must be the way to gain skills in serious and infrequent situations, without harm for the patient. Special attention is focussed on the definition of nosocomial infection preventive factors, and new increasingly contrasted and simplified diagnostic and therapeutic protocols are being promoted, based on scientific evidence.
The description of empediatric
In this context, our care must be extended to the out-hospital setting. Considerable and very favorable experience has already been gained in this field. Integration of these children within the family nucleus is very satisfactory, both physically and psychologically, for both the patients and their relatives—with improved quality of life and a lessened social burden. In turn, our care units obtain benefits in the form of the optimization of resources, with a lesser psychological burden for the professionals, and finally the administration derives a lesser cost burden.
In effect, our knowledge, adequate data interpretation, and effective treatment interventions would be of no help without our human resources. In this sense, our nursing staff members are a key factor.
Specialization in this healthcare sector will be a crucial element for advancing in pediatric intensive care. Thus, optimization in the obtainment of data can be seen in the future of pediatric intensive care. Less invasiveness and increased effectiveness the idea is to think more about of the child than the disease itself.
The aim will be to apply scientifically correct and contrasted treatments.
Multicenter protocols will be developed to correlate experiences and reduce the margins of error. The patient and family must receive an adequate environment, modifying that of the intensive care unit proper, readapting our classical schemes of rigorous coded circulation, and opening our units to parents and relatives who as a result of their proximity can better understand the problems of their critically ill child and our efforts to offer the best possible care.
Lastly, patient safety will be guaranteed through teaching in simulated settings and virtual reality environments.
In sum, we will strive to be as human as we are scientists and technicians. References J. Fernandez et al. Regarding the systemic variables, 9,35—37,39,40 the presence of hyperglycemia, shock or anemia was associated to increased mortality.
In this same sense, White et al. The better prognosis of HIs in pediatric patients vs adults has been evidenced by many studies 33,38,41 — mortality in turn being higher among the lower age ranges in the pediatric population.
On the other hand, we observed no differences in mortality between patients with pure HIs or HIs associated to polytraumatism, in coincidence with the results published by Feickert et al. Another relevant observation was that mortality in pediatric SHIs was generally recorded in early phases, since the PICU stay in these cases was significantly shorter than in those patients who did not die 4. We therefore consider that the factors which should be analyzed in relation to mortality in pediatric patients are early-stage factors upon admission, first 24h , since this is the period defining the prognosis of children with SHIs.
Lastly, in reference to mortality in pediatric SHIs, and despite the problem of sample homogenization, we recorded a clear tendency towards lessened mortality in the last decade This may have been influenced by optimization in the diagnosis and treatment of patients with SHIs, as well as by improvements in traffic safety, the incorporation of more advanced safety systems in vehicles, etc.
However, there is still no consensus on the ideal time to propose the procedure, nor what its real benefits are.
The latest treatment guidelines for the pediatric patient recommend it as an option in patients with progressive deterioration of the level of consciousness, incipient signs of cerebral herniation or refractory ICH in the initial stages of treatment [ 14 ].
The experience accumulated by the senior author and his team since with the use of DC for the control of ICH in pediatric patients and adults with severe TBI as well as ischemic and hemorrhagic strokes, constitutes the first approach to this topic in our country and led us to pose the following research problem: How to reduce ICP early in pediatric patients with severe TBI with associated ICH, to reduce secondary brain damage and improve morbidity and mortality?
The hypothesis that early use of DC can control ICP in pediatric patients with severe TBI and uncontrollable ICH and thus improve short-term results led us to consider the following research objectives: To evaluate in a general way the usefulness of early DC in pediatric patients with severe TBI, the time elapsed from the moment of trauma to the arrival at the neurotrauma center, the Glasgow coma scale GCS on admission and its possible association with the discharge results, and to evaluate the results of the CT images on admission and sequential, as well as the behavior of ICP and CPP.
Patient and Methods A longitudinal prospective descriptive study of correlation type was carried out with all the patients admitted to the pediatric intensive care unit, with the diagnosis of severe TBI, in the period between January and December The universe was represented by 36 patients from 1 month of age up to 18 years, attended in the pediatric intensive care unit of our hospital; the sample corresponds to the universe.
The information was obtained at the time of admission and during the hospital stay, which was poured into a data collection notebook prepared for the study, which considered variables such as age, sex, personal and family medical history, neurosurgical history, origin and month in which the accident or trauma occurred, as well as the day of the week.
Variables related to the traumatic event were also contemplated, such as: Clinical status at the moment of admission evaluated by the GCS [ 15 ], time elapsed from the moment of trauma to moment of initial care at the neurotrauma center, health transportation used, pre- hospitalization therapeutic measures, characteristics of CT scan images on admission and sequential imaging results, behavior of the ICP, CPP, results of the calculation of the pressure-volume relation and complications.
Age The patients were divided into three subgroups according to their age and normal values of ICP: Infants from 30 days of age to 11 months and 29 days, pre-scholars from one to four years, school children from five to 18 years. Subgroup I included patients with eight points, subgroup II scored between seven and six points and subgroup III patients scored between five and four points.
Indications and analysis of CT scan images CT scan studies were performed on admission and after every 72 hours. Urgent CT scan was also indicated for any deterioration of the neurological status or sustained elevations of the ICP above the normal values for each age group for 15 minutes. The evaluation of the emergency CT scan images was done by the neurosurgeon on duty and the subsequent imaging results were discussed by a group of specialists constituted by neurosurgeons, radiologist and pediatric intensivists, with the aim of obtaining a collegiate diagnosis and consequently adopt the treatment.
The CT scan images on admission were evaluated according to the classification of Marshall, et al. The shift of the midline was calculated in millimeters and divided into subgroups: a Between one and five, b Between six and 10, c Greater than For the better analysis, subsequent CT images were divided into three subgroups qualitatively and the categories were considered as follows: a Improved, b Equal, c Worse.
Continuous ICP monitoring Continuous ICP monitoring was done by placing a catheter in the lateral ventricle of the most affected side, determined clinically or using imaging results.
When it was not possible to perform the ventriculostomy, the catheter was placed in the subarachnoid or intraparenchymal space and in all cases, it was externalized by epicranial subcutaneous tunneling, three centimeters distant from the surgical wound to reduce the risk of infection. The catheter was connected to a monitoring device with an external pressure transducer Integra Neuroscience that, after having been properly calibrated, transforms the liquid wave pressure wave into an electrical signal that is amplified and displayed on the screen of a monitor Life Scope of the Nihon Koden or Doctus VII of national manufacture , through the use of the invasive monitoring circuit of the MAP or the low pressure channel, with which it is possible to obtain its graphic registration.
Patients were divided according to the ICP values for each age group.
Children older than 1 year: Normal values between mmHg, as the range of pressures is as wide as the age range, this group is divided into two subgroups considering the existence of buffer mechanisms up to four years approximately in children aged years in a Less than 10 mmHg and b Greater than 10 mmHg. For the children between years in a Less than 15 mmHg and b Greater than 15 mmHg.
ICH was treated when the values were higher than the normal value for each age group, with the exception of those that presented intracranial space-occupying lesions, located in the uncus of the temporal lobe or in the basal frontal region, in which therapeutic behaviors were evaluated personally. Methods Used to Control ICP Those who showed normal values for their age for 24 hours, the catheter was removed, and they continued with general support measures until their recovery.
Sedation was performed predominantly with short half-life benzodiazepines, such as midazolam, at doses of 0. If control was not achieved with this measure, cerebrospinal fluid was drained through the ventriculostomy. Serial extractions were performed on no more than four occasions in one hour, with a maximum of five milliliters each time.
If the high ICP levels were maintained, neuromuscular relaxation was done with pancuronium methyl bromide, using an attacking dose of 0.
The surgical procedures used were the bifrontal DC, which is limited forward by both orbital rims floor of the frontal base , backwards by the coronal suture and laterally by both zygomatic arches.
The uni or bilateral fronto-temporo-parietal DC, is another technique of DC, the diameter of this variant is limited in front by the frontal sinus, at the upper end it is located one-centimeter lateral to the sagittal midline, the lower end reaches the zygomatic arch it includes all the temporal scale to the cranial base and behind it extends to a vertical line located at approximately 2 cm behind the trailing edge of the auricle.Regarding the systemic variables, 9,35—37,39,40 the presence of hyperglycemia, shock or anemia was associated to increased mortality.
Lopez Herce, M. Sedation was performed predominantly with short half-life benzodiazepines, such as midazolam, at doses of 0.
For the children between years in a Less than 15 mmHg and b Greater than 15 mmHg. Patient and Methods A longitudinal prospective descriptive study of correlation type was carried out with all the patients admitted to the pediatric intensive care unit, with the diagnosis of severe TBI, in the period between January and December In one case 7.
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