Hello Marc et al,
If you have not, I suggest you review this recent guideline from SCCM. It addresses your question with an evidence based approach to severe TBI. Ehud covered a lot of the key aspects of medical management of elevated ICP.
Pediatr Crit Care Med. 2012 Jan;13 Suppl 1:S1-82. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents
Tom, I had an opportunity to hear Peter Kochanek from Pittsburgh, the lead author of the working group that published these guidelines. He was a guest speaker at our institution earlier this year. In general, the peds. intensivists disapprove of our use of etomidate. Their concern surrounds the issue of adrenal suppression, particularly since these patients are at high risk for sepsis. Ketamine or propofol (if hemodynamics are normal) may be better options for sedation in these patients.
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