Traumatic brain injury (TBI) continues to be a leading cause of death and disability in children worldwide and in a recent UK epidemiological study TBI in children (leading to intensive care unit admission) occurred in 5.6 per 100 000 population (for 1–14 year olds) (Parslow et al 2005). The primary aim of the intensive care management of severe TBI is the minimisation of secondary injury of cerebral oedema and worsening cerebral ischaemia (Reilly and Bullock 2005; p 294). The intensive care nurse has a key role to play in recognising and minimising these secondary injury processes, which can significantly affect the child’s outcome and in promoting intracranial pressure and cerebral perfusion pressure stability whenever possible. This often presents a dilemma for the nurse, who just by performing essential nursing interventions or “cares” for the child may in fact produce significant physiological instability. The lack of strong paediatric evidence upon which to guide nursing practice has resulted in huge variations in paediatric intensive care unit nursing practice nationally (Tume 2007) and made nursing practice in this area reliant largely on intuition rather than evidence.
This lecture will discuss the pathology of TBI in children, an overview of the intensive care management and will review the physiological basis for and the evidence base for nursing practice in severe TBI.