Survey of the use of intracranial pressure monitoring in children in the United Kingdom

Objective: To establish current practice for the monitoring and management of acute intracranial hypertension in children in United Kingdom intensive care units (ICUs). Design: Postal questionnaire, targetted by prior telephone survey, to all I CUs admitting five or more children per annum with acute neurological illne ss. Results: Of the units contacted 70% responded, approximately one-half of wh ich reported the use of intracranial pressure (ICP) monitoring. Only data f rom these units are presented. Nearly all of these units consider monitorin g following serious head injury, but its use in nontraumatic brain injury i s less widespread. The decision to institute ICP monitoring is based mainly upon neuroimaging appearances and Glasgow Coma Scale score. ICP and cerebr al perfusion pressure targets differ markedly between centres, with only 46 % and 65% of units, respectively, setting age-dependent parameters. Mannito l and varying degrees of hyperventilation are employed by all units to lowe r ICP. The majority also use barbiturates, diuretics, and fluid restriction . Controlled hypothermia is used in 52% of units. Paediatric units are more likely to employ age-dependent cerebral perfusion pressure targets. Specif ic therapies employed to lower ICP are similar to those used in adult centr es. Conclusion: Faced with a lack of both evidence and consensus, the managemen t of acute intracranial hypertension in childhood varies widely. National o r international guidelines for the management of children with raised intra cranial pressure are needed. These should incorporate the physiological dif ferences between children of different ages.