PICU Pathway for Severe Traumatic Brain Injury (TBI)
Contact Information
Neurosurgery Resident: 10781
Trauma Fellow: 10258
Order Set
Critical Care Increased ICP Medications
Critical Care Traumatic Brain Injury
Patient with Traumatic Brain Injury (TBI)
(Admit via ED/Transport)
Notify Neurosurgery - Trauma Alert as per Protocol
Acute ED Management
GCS ≤ 8
ED Management
Within 30 minutes
of arrival
  • ATLS protocol
  • AVOID hypotension
  • Avoid hypoxia – wean supplemental
    O2 to SpO2 > 92 and < 98%
Acute Radiology/OR Management
Immediate Neurosurgical Management in OR:
  • Epidural hematoma
  • Midline shift with a mass lesion
Acute Critical Care Management
Within 1-2 hours
of PICU arrival
Admit to PICU
cEEG Monitoring (CT Compatible)
x 48 Hours Minimum
Consult Neurology – Order Seizure Action Plan
Interventions for Treating Elevated ICP & Physiologic Monitoring Parameters
Main Goals
  • ICP < 20 via normocarbia
    (arterial CO2 35-39; EtCO2 30-34)
  • Cerebral perfusion pressure
    (CPP > 40)
  • Avoid hypotension
  • Adequate brain oxygenation
    (PbtO2 ≥ 15 - ≤ 35 mmHg)
  • Avoid fever, hypoglycemia
Call PICU fellow/CRNP if any of these values are out of range for
> 5 minutes
Normal ICP x 48 hours:
De-escalate invasive monitoring
Posted: July 2015
Revised: October 2017
Authors: J. Huh, MD; K. Agarwal, RN; J. McCloskey, MD; J. Lavelle, MD; G. Heuer, MD; M. Priestley, MD; T. Kilbaugh, MD; M. Zonfrillo, MD, A. Donoghue, MD; K. Biggie, CRNP; S. Warrington, PharmD; M. Ferguson, MD; Shih-shan Chen, MD