ECMO-/ECLS

electrolyte imbalance and hypovolemia. Recent data suggests that 3%
hypertonic saline should be used as the mainstay therapy to maintain serum Na
concentrations of 150-170 mEq/L and serum osmolarity of 360 mOsm/L.
Serum osmolarity of 360 mOsm/L has been reported to be well tolerated in the
pediatric patient with a head injury [27]. Hypertonic saline has also been
reported to have several other potentially beneficial effects which include
vasoregulatory, hemodynamic, neurochemical, and immunologic properties.
Initial therapy should be 3 - 5 mL/kg or continuous infusion of 0.1 – 1.0 mL/kg/hr
titrated to decreased ICP. Myelinolysis is more likely to occur with a rapid
transition from hyponatremia to hypernatremia.
Early posttraumatic seizures (EPTS) occur in 19% of children [28].
EPTS occur within the first 7 days of injury. Children suffer from EPTS much
more often than adults and this may lead to secondary brain injury with
increased ICP and metabolic demands. Recommendations for monitoring
include EEG. EPTS are associated with late posttraumatic (greater than 7 days
after injury) seizures. Young age and non-accidental trauma are independent
predictors for the development of seizures. Treatment includes a loading dose
of phenobarbital 15-20 mg/kg as a single dose with maintenance dose given
12 - 24 hours later at 5 mg/kg/day divided every 12 hrs and subsequently titrated
for therapeutic levels at 15-40 mcg/mL. Class II evidence exists supporting the
use of prophylactic anticonvulsants in adults but no compelling data exists in
the pediatric literature to show these medications improves long-term outcome
or reduces PTS [8].