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

被引：248

作者：

Chesnut, Randall ^{[1
,2
]}

Aguilera, Sergio ^{[3
,4
]}

Buki, Andras ^{[5
,6
,7
]}

Bulger, Eileen ^{[8
]}

Citerio, Giuseppe ^{[9
,10
]}

Cooper, D. Jamie ^{[11
,12
]}

Arrastia, Ramon Diaz ^{[13
]}

Diringer, Michael ^{[14
]}

Figaji, Anthony ^{[15
,16
]}

Gao, Guoyi ^{[17
]}

Geocadin, Romer ^{[18
]}

Ghajar, Jamshid ^{[19
]}

Harris, Odette ^{[20
]}

Hoffer, Alan ^{[21
]}

Hutchinson, Peter ^{[22
,23
]}

Joseph, Mathew ^{[24
]}

Kitagawa, Ryan ^{[25
]}

Manley, Geoffrey ^{[26
,27
]}

Mayer, Stephan ^{[28
]}

Menon, David K. ^{[29
,30
]}

Meyfroidt, Geert ^{[31
,32
]}

Michael, Daniel B. ^{[33
]}

Oddo, Mauro ^{[34
]}

Okonkwo, David ^{[35
]}

Patel, Mayur ^{[36
]}

Robertson, Claudia ^{[37
]}

Rosenfeld, Jeffrey V. ^{[38
,39
]}

Rubiano, Andres M. ^{[40
,41
]}

Sahuquillo, Juan ^{[42
]}

Servadei, Franco ^{[43
,44
,45
]}

Shutter, Lori ^{[46
]}

Stein, Deborah ^{[47
,48
]}

Stocchetti, Nino ^{[49
,50
]}

Taccone, Fabio Silvio ^{[51
]}

Timmons, Shelly ^{[52
]}

Tsai, Eve ^{[53
]}

Ullman, Jamie S. ^{[54
]}

Vespa, Paul ^{[55
]}

Videtta, Walter ^{[56
]}

Wright, David W. ^{[57
]}

Zammit, Christopher ^{[58
]}

Hawryluk, Gregory W. J. ^{[59
]}

机构：

[1] Univ Washington, Harborview Med Ctr, Dept Neurol Surg, 325 Ninth Ave,Mailstop 359766, Seattle, WA 98109 USA

[2] Univ Washington, Dept Orthopaed Surg, Harborview Med Ctr, 325 Ninth Ave,Mailstop 359766, Seattle, WA 98109 USA

[3] Almirante Nef Naval Hosp, Vina Del Mar, Chile

[4] Univ Valparaiso, Valparaiso, Chile

[5] Sch Med, Dept Neurosurg, Ifjusag Utja 20, H-7624 Pecs, Hungary

[6] Szentagothai Res Ctr, Ifjusag Utja 20, H-7624 Pecs, Hungary

[7] Univ Pecs, Pecs, Hungary

[8] Univ Washington, Dept Surg, Harborview Med Ctr, 325 Ninth Ave, Seattle, WA 98104 USA

[9] Univ Milano Bicocca, Sch Med & Surg, Milan, Italy

[10] San Gerardo Hosp, ASST, Dept Emergency & Intens Care, Neurointens Care, Monza, Italy

[11] Monash Univ, Australian & New Zealand Intens Care Res Ctr, Intens Care Med, Monash, Australia

[12] Alfred Hosp, Dept Intens Care, Melbourne, Vic, Australia

[13] Univ Penn, Perelman Sch Med, Penn Presbyterian Med Ctr, 51 North 39th St, Philadelphia, PA 19104 USA

[14] Washington Univ, Sch Med, Dept Neurol, Barnes Jewish Hosp, 1 Barnes Jewish Hosp Plaza, St Louis, MO 63110 USA

[15] Univ Cape Town, Div Neurosurg, Groote Schuur Hosp, H53 Old Main Bldg,Main Rd, ZA-7925 Observatory, South Africa

[16] Univ Cape Town, Inst Neurosci, Groote Schuur Hosp, H53 Old Main Bldg,Main Rd, ZA-7925 Observatory, South Africa

[17] Shanghai Jiao Tong Univ, Renji Hosp, Shanghai Inst Head Trauma, Sch Med,Dept Neurosurg, 1630 Dongfang Rd, Shanghai 200127, Peoples R China

[18] Johns Hopkins Univ, Sch Med, 1800 Orleans St Sheikh Zayed Tower, Baltimore, MD 21287 USA

[19] Stanford Neurosci Hlth Ctr, 213 Quarry Rd 4th Fl MC 5958, Palo Alto, CA 94304 USA

[20] Dept Neurosurg, Pasteur Dr,Room R205,Edwards Bldg,MC 5327, Stanford, CA 94305 USA

[21] Case Western Reserve Univ, Sch Med, Dept Neurol Surg, 11100 Euclid Ave,HAN 5042, Cleveland, OH 44106 USA

[22] Addenbrookes Hosp, Dept Clin Neurosci, Div Neurosurg, Cambridge Biomed Campus, Cambridge CB2 0QQ, England

[23] Univ Cambridge, Cambridge Biomed Campus, Cambridge CB2 0QQ, England

[24] Christian Med Coll & Hosp, Dept Neurol Sci, Ida Scudder Rd, Vellore, Tamil Nadu, India

[25] McGovern Med Sch UTHlth, Vivian L Smith Dept Neurosurg, 6400 Fannin St,Suite 2800, Houston, TX 77030 USA

[26] Univ Calif San Francisco, San Francisco Gen Hosp, 1001 Potrero Ave,Bldg 1,Room 101, San Francisco, CA 94110 USA

[27] Trauma Ctr, 1001 Potrero Ave,Bldg 1,Room 101, San Francisco, CA 94110 USA

[28] Henry Ford Hosp, Neurol, K-11,2799 W Grand Blvd, Detroit, MI 48202 USA

[29] Univ Cambridge, Div Anaesthesia, Hills Rd,Box 93, Cambridge CB2 0QQ, England

[30] Addenbrookes Hosp, Hills Rd,Box 93, Cambridge CB2 0QQ, England

[31] Univ Hosp Leuven, Dept & Lab Intens Care Med, Herestr 49,Box 7003 63, B-3000 Louvain, Belgium

[32] Katholieke Univ Leuven, Herestr 49,Box 7003 63, B-3000 Louvain, Belgium

[33] Oakland Univ, William Beaumont Sch Med, Beaumont Hlth, Michigan Head & Spine Inst, Southfield, MI USA

[34] Univ Lausanne, CHUV Lausanne Univ Hosp, Dept Intens Care Med, Fac Biol & Med, Lausanne, Switzerland

[35] Univ Pittsburgh, Med Ctr, Dept Neurosurg, Pittsburgh, PA USA

[36] Vanderbilt Univ, Med Ctr, Nashville, TN USA

[37] Baylor Coll Med, One Baylor Plaza, Houston, TX 77030 USA

[38] Alfred Hosp, Dept Neurosurg, Melbourne, Vic, Australia

[39] Monash Univ, Dept Surg, Melbourne, Vic, Australia

[40] El Bosque Univ, INUB MEDITECH Res Grp, Neurosci Inst, Bogota, Colombia

[41] MEDITECH Fdn, Clin Res, Calle 7-A 44-95, Cali 760036, Colombia

[42] Univ Hosp Vall Hebron, Barcelona, Spain

[43] Humanitas Univ, Dept Neurosurg, Milan, Italy

[44] Res Hosp, Milan, Italy

[45] World Federat Neurosurg Soc, Nyon, Switzerland

[46] Univ Pittsburgh, Med Ctr, 3550 Terrace St,Room 646, Pittsburgh, PA 15261 USA

[47] Univ Calif San Francisco, Zuckerberg San Francisco Gen Hosp, 1001 Potrero Ave,Ward 3A, San Francisco, CA 94110 USA

[48] Univ Calif San Francisco, Ctr Trauma, 1001 Potrero Ave,Ward 3A, San Francisco, CA 94110 USA

[49] Milan Univ, Dept Physiopathol & Transplantat, Milan, Italy

[50] Osped Maggiore Policlin, Fdn IRCCS Ca Granda, Neurosci Intens Care Unit, Milan, Italy

来源：

INTENSIVE CARE MEDICINE | 2020年 / 46卷 / 05期

关键词：

Brain injury; Head trauma; Algorithm; Protocol; Consensus; Intracranial pressure; Brain oxygen; Tiers; Seattle; SIBICC; PbtO2; GUIDELINES; TRIAL;

D O I：

10.1007/s00134-019-05900-x

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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.

引用

页码：919 / 929

页数：11

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