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Bright Futures

Articles and Updates from Phoenix Children's

March 16, 2021, Appavu, Brian, MD ,
Neurocritical Care Means Coordinated Care for Your Child’s Brain
Neurocritical Care Means Coordinated Care for Your Child’s Brain

We raise our children with love and look forward to a future where our children will flourish. We watch our children in awe as they grow into their own special persons with each day that passes. We anticipate the best for our children. We do not, though, anticipate unforeseen injuries that might alter their futures. It is not surprising to report, then, that when children arrive to our hospital with new brain injuries, families experience many difficult emotions, some of which are disbelief, shock and grief.

At Barrow Neurological Institute at Phoenix Children’s, children may present with acute brain injuries due to trauma, stroke, brain infections or other situations where there is a lack of oxygen to the brain. Such children often arrive to one of our intensive care units, where a multitude of physicians, nurses and medical technicians will arrive to the child with one unified goal: preventing worsened brain injury and ensuring the best possible outcome. The sudden shock of a new brain injury to their child, in combination with the fluidity and acute nature of the intensive care environment, often leaves families overwhelmed and unsure about what is happening to their child.

Preventing Worsened Brain Injury

The goals of our pediatric Neurocritical Care Program are to prevent worsening brain injury in critically ill children, to effectively communicate with families the nature of their child’s injury, and to facilitate their road to the best recovery possible. Critically ill children often lack the ability to breath on their own, either due to their injury or the sedating medications needed to care for them. In the immediate days after injury, physicians of different fields will care for these children, all coming with different areas of expertise. Some physicians closely look at brain activity, while other physicians focus on blood pressure, ventilator management, or surgical devices. As a team, we bring all of our specialties to the forefront to help each and every child who comes to our hospital.

At Phoenix Children’s Hospital, we take pride in the coordination of care and technology we implement to deliver the best care for critically ill children and their families. At the core of our neurocritical care program is a team of 4 critical care neurologists and 2 advanced practitioners who see critically ill children with brain injuries and those at high risk of such injuries. In the critically ill period, we work closely with pediatric intensivists, neurosurgeons, and other specialists to ensure that all is done to effectively care for these children.

In the acute period, we use advanced technologies to understand brain function. Electroencephalography can assess how the cortex of the brain is functioning and is used to detect for seizures and understand the severity of encephalopathy. Transcranial doppler ultrasound is used to assess how well the brain is receiving blood flow. Multimodal monitoring allows us to integrate a host of monitoring devices to understand how well the brain regulates blood flow and efficacy of treatments used in care. Functional magnetic resonance imaging allows us to assess brain networks. We use the most advanced technologies with a high level of skill to best understand how the brain is functioning during critical illness, and how to best provide an environment of brain injury homeostasis and recovery.

Communication with Families

A core task of the neurocritical care team is to effectively communicate with families the nature of their child’s brain injury and to provide their most appropriate neurologic prognosis. We do everything we can for our patients, and we aim to be clear with families when situations are difficult. We used advanced monitoring and state-of-the-art neuroimaging to understand the degree of brain injury and understand its impact of a child’s function and quality of life. We work alongside our colleagues in intensive care and palliative care such that everyone is on the same page regarding a child’s prognosis, and how it aligns with the goals of their family. We aim to give hope to those children who have a chance toward recovery, but also provide necessary information to families when medical interventions do not align with the desires they have for their loved ones. Our team takes pride in maintaining ongoing communication with families during critical illness and talking with them in situations where very acute care can be overwhelming and stressful.

Facilitating Recovery

As children transition from the pediatric intensive care unit toward the regular hospital floor or rehabilitation unit, our neurocritical care team helps towards the transition toward rehabilitation and recovery. We continue to work toward decreasing medications that are no longer necessary. We facilitate the transition toward ICU recovery clinics. We evaluate for signs of post-intensive care syndrome (PICS), which often affects children who survive acute brain injury. We facilitate the coordination towards clinics providing specialized care of stroke, epilepsy, neuropsychology, or complex tone where long-term needs are best served. This comprehensive approach helps in the process of functional recovery. Also, by seeing our patients in the recovery phase, we continuously inform our own decision making regarding how we deliver prognostication to families we meet in the ICU.

Our Research and Future

Our pediatric neurocritical care team is actively involved in clinical research aimed at improving acute brain injury care. Our team members are the primary recipients of numerous research grants from the United States Department of Defense, American Heart Association, University of Arizona Valley Research Partnership and other local foundations. Through such funding, we are actively studying predictors of brain injury in children requiring mechanical circulatory support and markers of epileptogenesis in children with traumatic brain injuries. Recently, a multitude of funding sources have started us to embark on a series of projects where we can use either electroencephalography or functional magnetic resonance imaging to detect for covert signs of consciousness in unresponsive children and to investigate whether these such signs may be associated with functional recovery. Through our clinical work and research, we are dedicated in providing hope and healing for the critically ill children we see and their families.

While no parent anticipates their child suffering a serious injury, we have the expertise to offer the very best care in those times of need.

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