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

被引：370

作者：

Hawryluk, Gregory W. J. ^{[1
]}

Aguilera, Sergio ^{[2
,3
]}

Buki, Andras ^{[4
,5
,6
]}

Bulger, Eileen ^{[7
]}

Citerio, Giuseppe ^{[8
,9
]}

Cooper, D. Jamie ^{[10
,11
]}

Arrastia, Ramon Diaz ^{[12
]}

Diringer, Michael ^{[13
,14
]}

Figaji, Anthony ^{[15
,16
]}

Gao, Guoyi ^{[17
]}

Geocadin, Romergryko ^{[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
,40
]}

Rubiano, Andres M. ^{[41
]}

Sahuquillo, Juan ^{[42
]}

Servadei, Franco ^{[43
]}

Shutter, Lori ^{[44
]}

Stein, Deborah ^{[45
,46
]}

Stocchetti, Nino ^{[47
,48
]}

Taccone, Fabio Silvio ^{[49
]}

Timmons, Shelly ^{[50
]}

Tsai, Eve ^{[51
]}

Ullman, Jamie S. ^{[52
]}

Vespa, Paul ^{[53
,54
,55
,56
]}

Videtta, Walter ^{[57
]}

Wright, David W. ^{[58
]}

Zammit, Christopher ^{[59
]}

Chesnut, Randall M. ^{[60
,61
,62
,63
]}

机构：

[1] Univ Manitoba, Sect Neurosurg, GB1,820 Sherbrook St, Winnipeg, MB R3A 1R9, Canada

[2] Valparaiso Univ, Almirante Nef Naval Hosp, Vina Del Mar, Chile

[3] Univ Valparaiso, Valparaiso, Chile

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

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

[6] Univ Pecs, Pecs, Hungary

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

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

[9] ASST Monza, Anaesthesia & Intens Care, San Gerardo & Desio Hosp, Monza, Italy

[10] Monash Univ, Australian & New Zealand Intens Care Res Ctr, Intens Care Med, Melbourne, Vic, Australia

[11] Alfred Hosp, Dept Intens Care & Hyperbar Med, Melbourne, Vic, Australia

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

[13] Washington Univ, Sch Med, Dept Neurol, St Louis, MO 63110 USA

[14] Barnes Jewish Hosp, Dept Neurol, 1 Barnes Jewish Hosp Plaza Suite 10400, St Louis, MO 63110 USA

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

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

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

[18] Johns Hopkins Univ, Sch Med, Dept Neurol, 600 N Wolfe St,Phipps 455, Baltimore, MD 21287 USA

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

[20] Dept Neurosurg, 300 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,5042, Cleveland, OH 44106 USA

[22] Univ Cambridge, Addenbrookes Hosp, Dept Clin Neurosci, Div Neurosurg, Cambridge CB20QQ, England

[23] Cambridge Biomed Campus, Cambridge CB20QQ, England

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

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

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

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

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

[29] Univ Cambridge, Addenbrookes Hosp, 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 Leuven, Belgium

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

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

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

[35] Univ Pittsburgh, Presbyterian Med Ctr, Dept Neurosurg, Suite B-400 200 Lothrop St, Pittsburgh, PA 15213 USA

[36] Vanderbilt Univ, Med Ctr, Dept Surg, 1211 21st Ave South,404 MAB, Nashville, TN 37212 USA

[37] Baylor Coll Med, Dept Neurosurg, 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, Neurosci Inst, INUB MEDITECH Res Grp, Bogota, Colombia

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

[42] Univ Hosp Vall dHebron, Dept Neurosurg, Barcelona, Spain

[43] Humanitas Univ & Res Hosp, Dept Neurosurg, Milan, Italy

[44] Univ Pittsburgh, Med Ctr, Dept Crit Care Med Neurol & Neurosurg, 3550 Terrace St,Room 646, Pittsburgh, PA 15261 USA

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

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

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

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

[49] ULB, Erasme Hosp, Dept Intens Care, Brussels, Belgium

[50] Dept Neurol Surg, GH 5100 SNEU, Indianapolis, IN 46202 USA

来源：

INTENSIVE CARE MEDICINE | 2019年 / 45卷 / 12期

关键词：

Brain injury; Head trauma; Algorithm; Protocol; Consensus; Intracranial pressure; Tiers; Seattle; SIBICC; DECOMPRESSIVE CRANIECTOMY; AUTOREGULATION; TRIAL;

D O I：

10.1007/s00134-019-05805-9

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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.

引用

页码：1783 / 1794

页数：12

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