Details

Autor(en) / Beteiligte

• Hawryluk, Gregory W. J.
• Aguilera, Sergio
• Buki, Andras
• Bulger, Eileen
• Citerio, Giuseppe
• Cooper, D. Jamie
• Arrastia, Ramon Diaz
• Diringer, Michael
• Figaji, Anthony
• Gao, Guoyi
• Geocadin, Romergryko
• Ghajar, Jamshid
• Harris, Odette
• Hoffer, Alan
• Hutchinson, Peter
• Joseph, Mathew
• Kitagawa, Ryan
• Manley, Geoffrey
• Mayer, Stephan
• Menon, David K.
• Meyfroidt, Geert
• Michael, Daniel B.
• Oddo, Mauro
• Okonkwo, David
• Patel, Mayur
• Robertson, Claudia
• Rosenfeld, Jeffrey V.
• Rubiano, Andres M.
• Sahuquillo, Juan
• Servadei, Franco
• Shutter, Lori
• Stein, Deborah
• Stocchetti, Nino
• Taccone, Fabio Silvio
• Timmons, Shelly
• Tsai, Eve
• Ullman, Jamie S.
• Vespa, Paul
• Videtta, Walter
• Wright, David W.
• Zammit, Christopher
• Chesnut, Randall M.

Titel

A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)

Ist Teil von

• Intensive care medicine, 2019-12, Vol.45 (12), p.1783-1794

Ort / Verlag

Berlin/Heidelberg: Springer Berlin Heidelberg

Erscheinungsjahr

2019

Link zum Volltext

Quelle

SpringerLink (Online service)

Beschreibungen/Notizen

• Background Management algorithms for adult severe traumatic brain injury (sTBI) were omitted in later editions of the Brain Trauma Foundation’s sTBI Management Guidelines, as they were not evidence-based. Methods We used a Delphi-method-based consensus approach to address management of sTBI patients undergoing intracranial pressure (ICP) monitoring. Forty-two experienced, clinically active sTBI specialists from six continents comprised the panel. Eight surveys iterated queries and comments. An in-person meeting included whole- and small-group discussions and blinded voting. Consensus required 80% agreement. We developed heatmaps based on a traffic-light model where panelists’ decision tendencies were the focus of recommendations. Results We provide comprehensive algorithms for ICP-monitor-based adult sTBI management. Consensus established 18 interventions as fundamental and ten treatments not to be used. We provide a three-tier algorithm for treating elevated ICP. Treatments within a tier are considered empirically equivalent. Higher tiers involve higher risk therapies. Tiers 1, 2, and 3 include 10, 4, and 3 interventions, respectively. We include inter-tier considerations, and recommendations for critical neuroworsening to assist the recognition and treatment of declining patients. Novel elements include guidance for autoregulation-based ICP treatment based on MAP Challenge results, and two heatmaps to guide (1) ICP-monitor removal and (2) consideration of sedation holidays for neurological examination. Conclusions Our modern and comprehensive sTBI-management protocol is designed to assist clinicians managing sTBI patients monitored with ICP-monitors alone. Consensus-based (class III evidence), it provides management recommendations based on combined expert opinion. It reflects neither a standard-of-care nor a substitute for thoughtful individualized management.