Table 3.

Treatments for Children with Severe TBI

Treatment	Level of Evidence	Recommendation
Hyperosmolar Therapy	Level II	Hypertonic saline acute bolus dose 6.5 – 10 ml/kg for increased ICP
	Level III	Continuous 3% saline dose 0.1 – 1.0 ml/kg/hr to maintain ICP < 20 mmHg and serum osmolarity <360 mOsm/L
Temperature Control	Level III	Avoid hyperthermia
CSF Drainage	Level III	CSF drainage through an EVD may be considered.
Barbiturates	Level III	High-dose barbiturate therapy in cases of refractory intracranial hypertension.
Decompressive craniectomy	Level III	Consider in early signs of neurologic deterioration or herniation or are developing intracranial hypertension refractory to medical management during the early stages of treatment.
Analgesics, sedatives, and neuromuscular blockade	Level III	Etomidate may be considered to control severe intracranial hypertension. Thiopental may be considered to control intracranial hypertension.
Antiseizure prophylaxis	Level III	Prophylactic treatment with phenytoin may be considered to reduce the incidence of early PTS.

ICP = intracranial pressure; CSF = cerebrospinal fluid; EVD = external ventricular device; mL = milliliter; kg = kilogram; hr = hour; PaCO2 = arterial carbon dioxide; PTS = posttraumatic seizures

Adapted from (Kochanek et al., 2012)