Κατεύθυνση Κλινική Νοσηλευτική: Εντατική και Επείγουσα ΝοσηλευτικήLibrary of the School of Health Sciences
Παύλος Μυριανθεύς, Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Κωνσταντίνος Τσουμάκας. Καθηγητής, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Ιωάννα Παυλοπούλου, Αναπληρώτρια Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Κρανιοεγκεφαλικές κακώσεις σε παιδιά: Ιδιαιτερότητες στη θεραπευτική αντιμετώπιση
Traumatic Brain injuries at children: Special considerations in treatment
Introduction / Purpose: Traumatic brain injuries in children have taken the form of an epidemic disease. Accidents are the leading cause of death and disability worldwide in children <1 year, higher than the sum of the other causes. Injuries to children and young people outweigh any other illness, which is the biggest health problem for these ages. 20-25% of pediatric emergencies account for accidents and about 70% of serious childhood injuries lead to death. Falls and vehicle injuries account for 80% of pediatric cases, and there is an increase in injured wounds. In severe injuries, 75% of children with multiple injuries have TBI and 80% of deaths are associated with severe TBI. There are many questions about dosages and whether the application of treatments that are effective in adults can also be applied to children. The peculiarity of the pediatric population is what makes it more difficult to conduct more research. The purpose of this review was to demonstrate the peculiarities in the therapeutic intervention of children with TBI and the peculiarities of the pediatric population.
Material and Method: Pubmed was used as source for the articles. The inclusion criteria were to be about humankind, to be within five years, the population is from birth to 18 years old and the language is English. From the 5516 articles that found initially, in the end and after apply of the inclusion and exclusion criteria, 17 articles remained.
Results: Overall, the publications on the therapeutic approach to concussion suggest physical and mental rest and return when the patient does not show a symptom and will not receive any medication. For heavy TBIs a combination of treatments and their individualization is suggested. Hypothermia appeared to be ineffective in treating high intracranial pressure, as opposed to decongestant craniectomy. Also, ketamine, a drug that was previously thought to increase ICP, the latest data showed it did not increase it, but it helped reduce it. Barbiturates are applied as a last resort or combined with another treatment. Of osmotic treatments, there was a superiority of the hypertonic solution to mannitol.
Conclusions: There are many gaps in the treatment of children with traumatic brain injuries and further investigations should be conducted to demonstrate the most appropriate therapeutic intervention. Children’s doses are lower than adults due to insufficient kidney and liver growth. Also, myelination is not complete and the head in infants is much larger than the rest of the body, so they are prone to TBI injuries. The nurses' contribution to the approach of patients with traumamtic brain injuries is important. Nurses being closer to the patient can identify changes to the patient, which may change his or her treatment approach.
Main subject category:
Traumatic brain injury, TBI, Children, Treatment, Corticosteroids, Craniectomy, Osmolar therapy
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