The brain in pediatric critical care: unique aspects of assessment, monitoring, investigations, and follow-up.
The brain in pediatric critical care: unique aspects of assessment, monitoring, investigations, and follow-up.
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DOI：
10.1007/s00134-022-06683-4
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发表时间：
2022-05
影响因子：
38.9
通讯作者：
Tasker, Robert C.
中科院分区：
文献类型：
--
作者：
Brown, Kate L.;Agrawal, Shruti;Kirschen, Matthew P.;Traube, Chani;Topjian, Alexis;Pressler, Ronit;Hahn, Cecil D.;Scholefield, Barnaby R.;Kanthimathinathan, Hari Krishnan;Hoskote, Aparna;D'Arco, Felice;Bembea, Melania;Manning, Joseph C.;Hunfeld, Maayke;Buysse, Corinne;Tasker, Robert C.
近年来，随着儿科重症监护病房(PICU)存活率的提高，目前一个关键的焦点是降低存活者的发病率和优化其生活质量。神经性疾病和直接脑损伤是PICU 11%-16%的入院原因。此外，许多危重儿童面临更高的脑损伤风险和影响晚年生活的神经发育困难，例如复杂的心脏病和早产。因此，使用神经危重护理的基本原则对大脑进行评估、监测和保护，对儿科重症监护医学的实践至关重要。对于入住PICU的儿童来说，对大脑功能的评估是指导适当护理所必需的，具有独特的挑战性。评估方面的挑战出现在不稳定的儿童身上，或者药物镇静和肌肉放松的儿童中，或者在病前发育异常的儿童中。此外，PICU患者疾病和年龄的异质性意味着高质量的证据比成人实践更难获得，尽管如此，近年来已经取得了很大进展。在这篇关于危重病儿童的最新论文中，我们讨论了1)有脑损伤风险的患者类型，2)适合年龄的新的标准化临床评估工具，脑功能的临床评估，3)与颅脑成像、非侵入性和侵入性脑监测相关的最新证据，4)儿童‘后强化综合征’的概念和神经发育随访的方法。更好地理解这些概念对于将PICU的存活率提高到一个新的水平至关重要。
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.
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影响因子：
5.6
作者：
Abend, Nicholas S.;Chapman, Kevin E.;Gallentine, William B.;Goldstein, Joshua;Hyslop, Ann E.;Loddenkemper, Tobias;Nash, Kendall B.;Riviello, James J., Jr.;Hahn, Cecil D.
通讯作者：
Hahn, Cecil D.
临床癫痫发作的治疗与完整期和近期新生儿的电学癫痫发作的影响：一项随机临床试验。
影响因子：
13.8
作者：
Hunt RW;Liley HG;Wagh D;Schembri R;Lee KJ;Shearman AD;Francis-Pester S;deWaal K;Cheong JYL;Olischar M;Badawi N;Wong FY;Osborn DA;Rajadurai VS;Dargaville PA;Headley B;Wright I;Colditz PB;Newborn Electrographic Seizure Trial Investigators
通讯作者：
Newborn Electrographic Seizure Trial Investigators
影响因子：
38.9
作者：
Guiza, Fabian;Depreitere, Bart;Meyfroidt, Geert
通讯作者：
Meyfroidt, Geert
影响因子：
3.8
作者：
Kharoshankaya, Liudmila;Stevenson, Nathan J.;Boylan, Geraldine B.
通讯作者：
Boylan, Geraldine B.
影响因子：
15.1
作者：
Ista, Erwin;van Beusekom, Babette;van Dijk, Monique
通讯作者：
van Dijk, Monique