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Severe Pediatric Traumatic Brain Injury (TBI), PICU — Decompressive Craniectomy Criteria — Clinical Pathway: Emergency, ICU and Inpatient

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

Decompressive Craniectomy Criteria

Criteria

Notify PICU and Neurosurgery Attendings, and Trauma fellow discussion of indication for decompressive craniectomy:

  • Persistent ICP > 20 with/without PbtO2 < 15 / CPP < 40 that fails to respond to escalation of therapies, including:
    • Adjusting HOB
    • Loosening collar
    • Increased sedation & analgesia
    • Failure to control seizures
    • 3% hypertonic saline bolus + infusion
    • Neuromuscular blockade bolus + infusion
    • Hyperventilation
    • Pentobarbital bolus + infusion

 

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