TY  - JOUR
AU  - Hawryluk, Gregory W J
AU  - Aguilera, Sergio
AU  - Büki, András
AU  - Bulger, Eileen
AU  - Citerio, Giuseppe
AU  - Cooper, D Jamie
AU  - Arrastia, Ramon Diaz
AU  - Diringer, Michael
AU  - Figaji, Anthony
AU  - Gao, Guoyi
AU  - Geocadin, Romergryko
AU  - Ghajar, Jamshid
AU  - Harris, Odette
AU  - Hoffer, Alan
AU  - Hutchinson, Peter
AU  - Joseph, Mathew
AU  - Kitagawa, Ryan
AU  - Manley, Geoffrey
AU  - Mayer, Stephan
AU  - Menon, David K
AU  - Meyfroidt, Geert
AU  - Michael, Daniel B
AU  - Oddo, Mauro
AU  - Okonkwo, David
AU  - Patel, Mayur
AU  - Robertson, Claudia
AU  - Rosenfeld, Jeffrey V
AU  - Rubiano, Andres M
AU  - Sahuquillo, Juan
AU  - Servadei, Franco
AU  - Shutter, Lori
AU  - Stein, Deborah
AU  - Stocchetti, Nino
AU  - Taccone, Fabio Silvio
AU  - Timmons, Shelly
AU  - Tsai, Eve
AU  - Ullman, Jamie S
AU  - Vespa, Paul
AU  - Videtta, Walter
AU  - Wright, David W
AU  - Zammit, Christopher
AU  - Chesnut, Randall M
TI  - A management algorithm for patients with intracranial pressure monitoring : the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)
JF  - INTENSIVE CARE MEDICINE
J2  - INTENS CARE MED
VL  - 45
PY  - 2019
IS  - 12
SP  - 1783
EP  - 1794
PG  - 12
SN  - 0342-4642
DO  - 10.1007/s00134-019-05805-9
UR  - https://m2.mtmt.hu/api/publication/30869114
ID  - 30869114
AB  - 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.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.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.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.
LA  - English
DB  - MTMT
ER  -