Severe pediatric head injury: The role of hyperemia revisited

Diffuse cerebral swelling is a frequent finding after severe pediatric head injury, and is two to five times as common in children as in adults, Hyper emia or cerebrovascular engorgement has long been considered by many as the cause of diffuse swelling and raised intracranial pressure (ICP), Conseque ntly, reduction of the vascular compartment by institution of hyperventilat ion and avoidance of mannitol has been advocated for the intensive care man agement of severely head-injured children. Suzuki and colleagues (1990) stu died cerebral blood flow (CBF) in 80 normal, unanesthetized children. It wa s shown that CBF in normal children may range from 40 mL/100 g per minute d uring the first 6 months of life to a peak of 108 mL/100 g per minute at ag e 3 to 4 years, and down to 71 mL/100 g per minute after age 9 years, Consi dering this large range, comparisons of CBF data in children are valid only when small, well-defined age ranges are selected. When the CBF values of c hildren with severe head injuries (described in previous research) were com pared with normal values in children, there did not seem to be a substantia l increase of CBF, Hyperemia may therefore not be as common in severe pedia tric head injury as previously thought. Until we acquire a better understan ding of the pathophysiology of severe pediatric head injury, and what the o ptimal treatment in children would be, there is no reason to treat children differently from adults.