Journal of Neuroanaesthesiology and Critical Care · Published 2026-07-13 · DOI 10.1055/s-0046-1819692
Ashish Bindra, Sharmishtha Pathak, Basavakiran Namdar, Muazzam Hasan, Keshav Goyal
Pediatric traumatic brain injury (pTBI) remains a major contributor to mortality and long-term morbidity worldwide. Management is challenging due to age-specific physiology, evolving brain maturation, and limited pediatric-specific evidence for advanced neurocritical care interventions. We report three challenging cases of severe pTBI requiring complex neurocritical care decision-making. The first case highlights the effective use of Tier-3 therapy using barbiturate-induced coma for refractory intracranial hypertension in a 3-year-old child with diffuse cerebral edema, demonstrating safe and sustained intracranial pressure control and delayed yet meaningful neurological recovery, facilitated by bispectral index-guided titration. The second case describes conservative yet vigilant management of post-extubation stridor in a 1-year-old infant with a compound skull fracture following surgical stabilization, successfully avoiding re-intubation through stepwise escalation of respiratory and pharmacologic support. The third case highlights the complexity of managing persistent intracranial hypertension after decompressive craniectomy in a 7-year-old child with concurrent acute respiratory distress syndrome, emphasizing strategies to balance lung-protective ventilation with cerebral physiology. These cases illustrate that timely, tailored neurocritical care interventions can successfully address complex challenges in pTBI, supporting meaningful recovery even in severe presentations.
Abstract from DOAJ. Public domain (CC0 1.0).
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Bindra, A., Pathak, S., Namdar, B., et al. (2026). Neurocritical Care Management Challenges in Pediatric Traumatic Brain Injury: Insights from Three Illustrative Cases. Journal of Neuroanaesthesiology and Critical Care. https://doi.org/10.1055/s-0046-1819692