Shore et al reported the Pediatric Intensity Level of Therapy (PILOT) to monitor intracranial pressure-directed therapies for pediatric traumatic brain injury. The authors are from University of Texas Southwestern Medical Center, Children's Medical Center of Dallas, Children's Hospital of Pittsburgh, University of Pittsburgh and Safar Center for Resuscitation Research (Pittsburgh).
Patient selection: pediatric patient <= 18 years of age with traumatic brain injury (TBI)
Parameters:
(1) treatment of fever (> 38.5°C) or spontaneous hypothermia (< 34.5°C)
(2) sedation, any dose
(3) neuromuscular blockade
(4) total dose of osmolar therapy in 24-hour period with mannitol
(5) osmolar therapy with hypertonic saline
(6) number of times CSF drained in 24-hour period
(7) total barbiturate dose in 24-hour period
(8) evacuation of hematoma
(9) decompressive craniotomy
(10) ventilation and PaCo2 in mm Hg (most frequently observed)
(11) induced hypothermia at any time during 24-hour period
(12) lumbar drain at any time during 24-hour period
(13) induced hypertension (>= 95th percentile for age) at any time during 24-hour period
|
Parameter
|
Finding
|
Points
|
|
treatment of temperature
|
no
|
0
|
|
|
yes
|
1
|
|
sedation
|
no
|
0
|
|
|
yes
|
1
|
|
neuromuscular blockade
|
no
|
0
|
|
|
yes
|
2
|
|
dose of mannitol
|
0
|
0
|
|
|
> 0 to 1 g/kg
|
1
|
|
|
mannitol 1.1-2.0 g/kg
|
2
|
|
|
mannitol > 2 g/kg
|
3
|
|
hypertonic saline
|
none
|
0
|
|
|
yes
|
3
|
|
times CSF drained
|
0
|
0
|
|
|
1 to 11
|
1
|
|
|
12 to 23
|
2
|
|
|
>= 24 or continuous
|
3
|
|
barbiturate dose
|
pentobarbital <= 36 mg/kg
|
3
|
|
|
pentobarbital > 36 mg/kg
|
4
|
|
|
thiopental <= 180 mg/kg
|
3
|
|
|
thiopental > 180 mg/kg
|
4
|
|
|
none
|
0
|
|
evacuation of hematoma
|
no
|
0
|
|
|
yes
|
4
|
|
decompression
|
no
|
0
|
|
|
yes
|
5
|
|
PaCO2
|
> 40 mm Hg
|
0
|
|
|
35.1 to 40 Hg (normal ventilation)
|
1
|
|
|
32 to 35 mm Hg (mild hyperventilation
|
2
|
|
|
< 32 mm Hg (aggressive hyperventilation)
|
4
|
|
induced hyperthermia
|
no
|
0
|
|
|
35 to 37°C (mild)
|
2
|
|
|
< 35°C (moderate)
|
4
|
|
lumbar drain
|
no
|
0
|
|
|
yes
|
2
|
|
induced hypertension
|
no
|
0
|
|
|
yes
|
2
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 38
• The highest PILOT scale score is seen in patients with severe TBI.
