734 SECTION VI Pediatric Critical Care Neurologic Gupta P, Rettiganti M, Gossett JM, Daufeldt J, Rice TB, Wetzel RC Development and validation of an empiric tool to predict favorable neurologic outcom[.]
734 S E C T I O N V I Pediatric Critical Care: Neurologic 30 10 20 10 tsne_z 0 –5 20 A 15 10 tsne_x –5 –10 ICU Admission hr prior to stroke hr post stroke Recovery –15 –10 –5 tsne_y –10 –20 10 –30 B –30 –20 –10 10 20 30 • Fig 60.5 (A) Pre- and posthemorrhagic stroke course in a 15-year-old with moyamoya vasculopathy represented using stochastic neighbor embedding (SNE) combining physiologic (cardiorespiratory, intracranial pressure) and laboratory monitoring to show “state” changes prior to and after the stroke (B) SNE display of quantitative electroencephalographic analysis (a/d power ratio) of infants with congenital heart disease after heart surgery with a stable course (red) compared with those with seizures (blue) The analysis represents 10 million data points from clinically acquired studies (A, Courtesy of Dwight Barry, PhD B, Courtesy Alexander Doud, MD.) different phenotypes of change linked to outcome.171 The identification of different injury phenotypes using neuromonitoring data implies that neuroprotection can be delivered specific to the pathology of an individual patient and adjusted precisely as the brain injury evolves or responds to treatment.67,172,173 These technologic advances in neuromonitoring hold great promise (Fig 60.5), but the foundation of effective neurocritical care is the clinical neurologic examination by the nurse and physician, anticipatory planning, serial examinations, standardized care, and effective communication between team members, principles that have not changed in decades Key References Adelson PD, Wisniewski SR, Beca J, et al Comparison of hypothermia and normothermia after severe traumatic brain injury in children (Cool Kids): a phase 3, randomised controlled trial Lancet Neurol 2013;12(6):546-553 Chambers I, Stobbart L, Jones P, et al Age-related differences in intracranial pressure and cerebral perfusion pressure in the first hours of monitoring after children’s head injury: association with outcome Childs Nerv Syst 2005;21:195-199 Figaji AA, Zwane E, Graham Fieggen A, Argent AC, Le Roux PD, Peter JC The effect of increased inspired fraction of oxygen on brain tissue oxygen tension in children with severe traumatic brain injury Neurocrit Care 2010;12(3):430-437 Gupta P, Rettiganti M, Gossett JM, Daufeldt J, Rice TB, Wetzel RC Development and validation of an empiric tool to predict favorable neurologic outcomes among PICU patients Crit Care Med 2018;46(1):108-115 Hutchinson J, Ward R, Lacroix J, et al Hypothermia therapy after traumatic brain injury in children (for the Hypothermia Pediatric Head Injury Trial Investigators and then Canadian Critical Care Trials Group) N Engl J Med 2008;358:2447-2456 Kochanek PM, Tasker RC, Bell MJ, et al Management of pediatric severe traumatic brain injury: 2019 consensus and guidelines-based algorithm for first and second tier therapies Pediatr Crit Care Med 2019;20(3):269-279 Lindsey HM, Wilde EA, Caeyenberghs K, Dennis EL Longitudinal neuroimaging in pediatric 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