Severe Pediatric Traumatic Brain Injury (TBI), PICU — Additional Considerations — Clinical Pathway: Emergency, ICU and Inpatient

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

Additional Care Considerations

Nutrition

Discuss with Neurosurgery & Trauma:

  • When feasible with trauma neurosurgery consider early enteral nutrition within support of 48-72 hrs.
  • If no evidence of basilar skull fracture, begin trophic feeds via enteral tube (NJ/NG) with a bowel regimen.
  • Advance feeds as tolerated.

If concern for basilar skull fracture:

  • DO NOT place a nasal enteral feeding tube.
  • Recommend an OG/OJ feeding tube.
  • If enteral feeding not indicated, recommend PN via CVL by day #2-3 of PICU admission.
  • Total fluid limit (TFL): should account for PN, IV fluids and other infusions such as 3% hypertonic saline.

Temperature Regulation — Daily reassessment of the need for targeted temperature management

Avoid hyperthermia (temp > 38° C). Treatment options include:

  • Acetaminophen (avoid NSAIDs due to increased bleeding risk)
  • Other cooling mechanisms (environmental adjustments)
  • Recommend cooling blanket to achieve normothermia but consider:

Consults Upon PICU Admission

  • PT
  • OT
  • Physical Medicine and Rehabilitation (PM&R)

Skin Care

Turn patients every 2 hrs – notify clinical team to discuss turning frequency
if needed.

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