Severe Pediatric Traumatic Brain Injury (TBI), PICU — De-escalate Invasive Monitoring — Clinical Pathway: Emergency, ICU and Inpatient

Traumatic Brain Injury (TBI) Clinical Pathway — Emergency Department and ICU

De-escalate Invasive Monitoring

Removal of invasive monitoring and therapies can likely begin after 24-48 hours of normal ICP and per discussion with PICU, Neurosurgery and Trauma team.

Wean infusion/intervention (if present) per patient condition as tolerated and per clinical team:

  • Pentobarbital infusion
  • Hyperventilation
  • Neuromuscular blockade infusion
  • 3% hypertonic saline infusion
  • Sedation infusions

Remove:

  • ICP monitor prior to extubation (per Neurosurgery)
  • Foley catheter
  • Extubate
  • Arterial line
  • CVL with CVP
  • C-spine (c-collar) if cleared by Trauma