Journal article

A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC).

  • Chesnut R Department of Neurological Surgery, Harborview Medical Center, University of Washington, 325 Ninth Ave, Mailstop 359766, Seattle, Washington, 98104-2499, USA.
  • Aguilera S Almirante Nef Naval Hospital, Viña del Mar, Chile.
  • Buki A Department of Neurosurgery, Medical School and Szentágothai Research Centre, Ifjúság útja 20, 7624, Pécs, Hungary.
  • Bulger E Department of Surgery, Harborview Medical Center, University of Washington, 325 Ninth Ave, Seattle, WA, 98104-2499, USA.
  • Citerio G School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
  • Cooper DJ Intensive Care Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Monash, Australia.
  • Arrastia RD University of Pennsylvania Perelman School of Medicine, Penn Presbyterian Medical Center, 51 North 39th Street, Philadelphia, PA, 19104, USA.
  • Diringer M Department of Neurology, Barnes-Jewish Hospital, Washington University School of Medicine, 1 Barnes-Jewish Hospital Plaza, St. Louis, MO, 63110, USA.
  • Figaji A Division of Neurosurgery and Neuroscience Institute, University of Cape Town, H53 Old Main Building, Groote Schuur Hospital, Main Road, Observatory, 7925, South Africa.
  • Gao G Department of Neurosurgery, Renji Hospital, Shanghai Institute of Head Trauma, Shanghai Jiaotong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China.
  • Geocadin R Johns Hopkins University School of Medicine, 1800 Orleans St. Sheikh Zayed Tower, Baltimore, MD, 21287, USA.
  • Ghajar J Stanford Neuroscience Health Center, 213 Quarry Rd 4th Fl MC 5958, Palo Alto, CA, 94304, USA.
  • Harris O Department of Neurosurgery, Pasteur Drive, Room R205, Edward's Building, MC 5327, Stanford, CA, 94305, USA.
  • Hoffer A Department of Neurological Surgery, School of Medicine, Case Western Reserve University, 11100 Euclid Avenue, HAN 5042, Cleveland, OH, 44106, USA.
  • Hutchinson P Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK.
  • Joseph M Department of Neurological Sciences, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India.
  • Kitagawa R Vivian L Smith Department of Neurosurgery, McGovern Medical School at UTHealth, 6400 Fannin St, Suite 2800, Houston, TX, 77030, USA.
  • Manley G University of California San Francisco, San Francisco General Hospital and Trauma Center, 1001 Potrero Ave., Bldg 1, Room 101, San Francisco, CA, 94110, USA.
  • Mayer S Neurology, K-11, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
  • Menon DK Division of Anaesthesia, University of Cambridge and Addenbrooke's Hospital, Addenbrooke's Hospital, Hills Road, Box 93, Cambridge, CB2 0QQ, UK.
  • Meyfroidt G Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Herestraat 49, Box 7003 63, 3000, Leuven, Belgium.
  • Michael DB Oakland University William Beaumont School of Medicine, Beaumont Health, Michigan Head and Spine Institute, Southfield, MI, USA.
  • Oddo M Department of Intensive Care Medicine, CHUV-Lausanne University Hospital, University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland.
  • Okonkwo D Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
  • Patel M Vanderbilt University Medical Center, Nashville, USA.
  • Robertson C Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
  • Rosenfeld JV Department of Neurosurgery, Alfred Hospital, Melbourne, Australia.
  • Rubiano AM INUB/MEDITECH Research Group, Neurosciences Institute, El Bosque University, Bogotá, Colombia.
  • Sahuquillo J University Hospital Vall D'Hebron, Barcelona, Spain.
  • Servadei F Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy.
  • Shutter L University of Pittsburgh Medical Center, 3550 Terrace St, Room 646, Pittsburgh, PA, 15261, USA.
  • Stein D Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, 1001 Potrero Ave., Ward 3A, San Francisco, CA, 94110, USA.
  • Stocchetti N Department of Physiopathology and Transplantation, Milan University, Milan, Italy.
  • Taccone FS Department of Intensive Care, Hospital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
  • Timmons S Department of Neurological Surgery, Penn State University Milton S. Hershey Medical Center, 30 Hope Dr., Suite 1200 | Building B, Hershey, PA, 17033, USA.
  • Tsai E Suruchi Bhargava Chair in Spinal Cord and Brain Regeneration Research, University of Ottawa, The Ottawa Hospital, C2 Neurosciences Unit, The Ottawa Hosptial, Civic Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
  • Ullman JS Department of Neurosurgery, Donald and Barbara Zucker School of Medicine At Hofstra/Northwell North, Shore University Hospital, 300 Community Drive, 9 Tower, Manhasset, NY, USA.
  • Vespa P Ronald Reagan UCLA Medical Center, UCLA Medical Center, Santa Monica, Santa Monica, USA.
  • Videtta W Posadas Hospital, Buenos Aires, Argentina.
  • Wright DW Emory University School of Medicine, 49 Jesse Hill Jr Dr, Atlanta, GA, 30303, USA.
  • Zammit C School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 655C, Rochester, NY, 14642, USA.
  • Hawryluk GWJ Section of Neurosurgery, University of Manitoba, GB1, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada. ghawryluk@hsc.mb.ca.
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  • 2020-01-23
Published in:
  • Intensive care medicine. - 2020
English BACKGROUND
Current guidelines for the treatment of adult severe traumatic brain injury (sTBI) consist of high-quality evidence reports, but they are no longer accompanied by management protocols, as these require expert opinion to bridge the gap between published evidence and patient care. We aimed to establish a modern sTBI protocol for adult patients with both intracranial pressure (ICP) and brain oxygen monitors in place.


METHODS
Our consensus working group consisted of 42 experienced and actively practicing sTBI opinion leaders from six continents. Having previously established a protocol for the treatment of patients with ICP monitoring alone, we addressed patients who have a brain oxygen monitor in addition to an ICP monitor. The management protocols were developed through a Delphi-method-based consensus approach and were finalized at an in-person meeting.


RESULTS
We established three distinct treatment protocols, each with three tiers whereby higher tiers involve therapies with higher risk. One protocol addresses the management of ICP elevation when brain oxygenation is normal. A second addresses management of brain hypoxia with normal ICP. The third protocol addresses the situation when both intracranial hypertension and brain hypoxia are present. The panel considered issues pertaining to blood transfusion and ventilator management when designing the different algorithms.


CONCLUSIONS
These protocols are intended to assist clinicians in the management of patients with both ICP and brain oxygen monitors but they do not reflect either a standard-of-care or a substitute for thoughtful individualized management. These protocols should be used in conjunction with recommendations for basic care, management of critical neuroworsening and weaning treatment recently published in conjunction with the Seattle International Brain Injury Consensus Conference.
Language
  • English
Open access status
hybrid
Identifiers
Persistent URL
https://folia.unifr.ch/global/documents/126569
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