Ventilation monitoring for severe pediatric traumatic brain injury during interfacility transport

Ventilatory management of critically ill children in the emergency setting, during transport and retrieval

Critical illness in children is uncommon. The acute stabilization and resuscitation of critically ill children remains challenging to even the most experienced operator. Cardiorespiratory illness represents the largest subgroup of diseases causing critical illness and, thus adds a layer of complexity and additional challenge to the safe intubation and establishment of effective ventilation of this group of children. Children have unique physiological and anatomical differences to adults, and present the team involved in their resuscitation and stabilization with challenges exaggerated by critical illness. The consideration of pathophysiological implications of disease and the equipment available during transport and retrieval from the roadside or nonspecialist setting to pediatric intensive care allows the clinician involved in resuscitation, stabilization, and establishment of ventilation to employ targeted strategies to optimize ventilatory success. This review focuses on the types of ventilatory challenges that must be addressed when managing critically ill children in the local settings in which they present, and the resources available to optimize the outcome prior to and during transfer to a higher level of care.

Computed Tomography Practice Standards for Severe Pediatric Traumatic Brain Injury in the Emergency Department: a National Survey

Acute medical management of traumatic brain injury (TBI) can be challenging outside of the resuscitation bay, specifically while obtaining a computed tomography (CT) scan of the brain. We sought out to determine the management practices of Canadian traumatologists for pediatric patients with severe TBI requiring CT in the emergency department (ED). In 2019, surveys were sent to trauma directors in hospitals across Canada to ascertain their clinical practices. Team members present in the CT scan included physicians (89%), registered nurses (100%), and respiratory therapists (38%). The average time to and from the CT scanner was one hour. Over half of respondents (56%) had experienced an adverse event in CT with variable access (11-56%) to necessary resuscitation equipment and medications. Significant hypotension (44%) was the most common adverse event experienced. With the exception of an end tidal CO2 monitoring (56%), heart rate, rhythm, respiratory rate, saturation, and blood pressure were always monitored during a CT scan. Head of bed elevation had an approximately equal distribution of flat (44%) versus elevated (56%). The practice variability of Canadian traumatologists may reflect a lack of evidence to guide patient management. Future research and knowledge translation efforts are needed to optimize patient care during neuroimaging.