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      Is Open Access

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

      case-report
      1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ,
      Intensive Care Medicine
      Springer Berlin Heidelberg
      Brain injury, Head trauma, Algorithm, Protocol, Consensus, Intracranial pressure, Brain oxygen, Tiers, Seattle, SIBICC, PbtO2

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          Abstract

          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.

          Electronic supplementary material

          The online version of this article (10.1007/s00134-019-05900-x) contains supplementary material, which is available to authorized users.

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          Most cited references8

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          • Abstract: found
          • Article: not found

          A trial of intracranial-pressure monitoring in traumatic brain injury.

          Intracranial-pressure monitoring is considered the standard of care for severe traumatic brain injury and is used frequently, but the efficacy of treatment based on monitoring in improving the outcome has not been rigorously assessed. We conducted a multicenter, controlled trial in which 324 patients 13 years of age or older who had severe traumatic brain injury and were being treated in intensive care units (ICUs) in Bolivia or Ecuador were randomly assigned to one of two specific protocols: guidelines-based management in which a protocol for monitoring intraparenchymal intracranial pressure was used (pressure-monitoring group) or a protocol in which treatment was based on imaging and clinical examination (imaging-clinical examination group). The primary outcome was a composite of survival time, impaired consciousness, and functional status at 3 months and 6 months and neuropsychological status at 6 months; neuropsychological status was assessed by an examiner who was unaware of protocol assignment. This composite measure was based on performance across 21 measures of functional and cognitive status and calculated as a percentile (with 0 indicating the worst performance, and 100 the best performance). There was no significant between-group difference in the primary outcome, a composite measure based on percentile performance across 21 measures of functional and cognitive status (score, 56 in the pressure-monitoring group vs. 53 in the imaging-clinical examination group; P=0.49). Six-month mortality was 39% in the pressure-monitoring group and 41% in the imaging-clinical examination group (P=0.60). The median length of stay in the ICU was similar in the two groups (12 days in the pressure-monitoring group and 9 days in the imaging-clinical examination group; P=0.25), although the number of days of brain-specific treatments (e.g., administration of hyperosmolar fluids and the use of hyperventilation) in the ICU was higher in the imaging-clinical examination group than in the pressure-monitoring group (4.8 vs. 3.4, P=0.002). The distribution of serious adverse events was similar in the two groups. For patients with severe traumatic brain injury, care focused on maintaining monitored intracranial pressure at 20 mm Hg or less was not shown to be superior to care based on imaging and clinical examination. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT01068522.).
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            • Article: not found

            Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial.

            There is limited information about the effect of erythropoietin or a high hemoglobin transfusion threshold after a traumatic brain injury.
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              • Record: found
              • Abstract: found
              • Article: not found

              Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II

              A relationship between reduced brain tissue oxygenation and poor outcome following severe traumatic brain injury has been reported in observational studies. We designed a Phase II trial to assess whether a neurocritical care management protocol could improve brain tissue oxygenation levels in patients with severe traumatic brain injury and the feasibility of a Phase III efficacy study.
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                Author and article information

                Contributors
                chesnutr@uw.edu
                aguilera71@gmail.com
                andras.buki@aok.pte.huc
                ebulger@uw.edu
                giuseppe.citerio@unimib.it
                Jamie.Cooper@monash.edu
                Ramon.Diaz-Arrastia@uphs.upenn.edu
                diringerm@neuro.wustl.edu
                anthony.figaji@uct.ac.za
                guoyigao@gmail.com
                rgeocad1@jhmi.edu
                jghajar@stanford.edu
                odette@stanford.edu
                Alan.Hoffer@uhhospitals.org
                pjah2@cam.ac.uk
                mjoseph@cmcvellore.ac.in
                Ryan.S.Kitagawa@uth.tmc.edu
                manleyg@ucsf.edu
                stephanamayer@gmail.com
                dkm13@cam.ac.uk
                geert.meyfroidt@uzleuven.be
                danielm@mhsi.us
                mauro.oddo@chuv.ch
                okonkwodo@upmc.edu
                mayur.b.patel@vumc.org
                claudiar@bcm.edu
                j.rosenfeld@alfred.org.au
                andresrubiano@aol.com
                sahuquillo@neurotrauma.net
                franco.servadei@hunimed.eu
                shutterla@upmc.edu
                deborah.stein@ucsf.edu
                nino.stocchetti@policlinico.mi.it
                ftaccone@ulb.ac.be
                stimmons@mac.com
                etsai@toh.ca
                jullman1@northwell.edu
                pvespa@mednet.ucla.edu
                wvidetta@yahoo.com.ar
                Christopher_Zammit@URMC.Rochester.edu
                ghawryluk@hsc.mb.ca
                Journal
                Intensive Care Med
                Intensive Care Med
                Intensive Care Medicine
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0342-4642
                1432-1238
                21 January 2020
                21 January 2020
                2020
                : 46
                : 5
                : 919-929
                Affiliations
                [1 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Neurological Surgery, , Harborview Medical Center, University of Washington, ; 325 Ninth Ave, Mailstop 359766, Seattle, Washington 98104-2499 USA
                [2 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Orthopaedic Surgery, , Harborview Medical Center, University of Washington, ; 325 Ninth Ave, Mailstop 359766, Seattle, Washington 98104-2499 USA
                [3 ]GRID grid.414892.2, Almirante Nef Naval Hospital, ; Viña del Mar, Chile
                [4 ]GRID grid.412185.b, ISNI 0000 0000 8912 4050, Valparaiso University, ; Valparaiso, Chile
                [5 ]GRID grid.9679.1, ISNI 0000 0001 0663 9479, Department of Neurosurgery, , Medical School and Szentágothai Research Centre, ; Ifjúság útja 20, 7624 Pécs, Hungary
                [6 ]GRID grid.9679.1, ISNI 0000 0001 0663 9479, University of Pécs, ; Pécs, Hungary
                [7 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Surgery, Harborview Medical Center, , University of Washington, ; 325 Ninth Ave, Seattle, WA 98104-2499 USA
                [8 ]GRID grid.7563.7, ISNI 0000 0001 2174 1754, School of Medicine and Surgery, , University of Milan-Bicocca, ; Milan, Italy
                [9 ]GRID grid.415025.7, ISNI 0000 0004 1756 8604, Neuro-Intensive Care, Department of Emergency and Intensive Care, , ASST, San Gerardo Hospital, ; Monza, Italy
                [10 ]GRID grid.1002.3, ISNI 0000 0004 1936 7857, Intensive Care Medicine, Australian and New Zealand Intensive Care Research Centre, , Monash University, ; Monash, Australia
                [11 ]GRID grid.1623.6, ISNI 0000 0004 0432 511X, Department of Intensive Care, , Alfred Hospital, ; Melbourne, VIC Australia
                [12 ]University of Pennsylvania Perelman School of Medicine, Penn Presbyterian Medical Center, 51 North 39th Street, Philadelphia, PA 19104 USA
                [13 ]GRID grid.239359.7, ISNI 0000 0001 0503 2990, Department of Neurology, , Barnes-Jewish Hospital, Washington University School of Medicine, ; 1 Barnes-Jewish Hospital Plaza, St. Louis, MO 63110 USA
                [14 ]Division of Neurosurgery and Neuroscience Institute, University of Cape Town, H53 Old Main Building, Groote Schuur Hospital, Main Road, Observatory, 7925 South Africa
                [15 ]GRID grid.16821.3c, ISNI 0000 0004 0368 8293, Department of Neurosurgery, , Renji Hospital, Shanghai Institute of Head Trauma, Shanghai Jiaotong University School of Medicine, ; 1630 Dongfang Road, Shanghai, 200127 China
                [16 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Johns Hopkins University School of Medicine, ; 1800 Orleans St. Sheikh Zayed Tower, Baltimore, MD 21287 USA
                [17 ]Stanford Neuroscience Health Center, 213 Quarry Rd 4th Fl MC 5958, Palo Alto, CA 94304 USA
                [18 ]GRID grid.240952.8, ISNI 0000000087342732, Department of Neurosurgery, ; Pasteur Drive, Room R205, Edward’s Building, MC 5327, Stanford, CA 94305 USA
                [19 ]GRID grid.67105.35, ISNI 0000 0001 2164 3847, Department of Neurological Surgery, School of Medicine, , Case Western Reserve University, ; 11100 Euclid Avenue, HAN 5042, Cleveland, OH 44106 USA
                [20 ]GRID grid.120073.7, ISNI 0000 0004 0622 5016, Division of Neurosurgery, Department of Clinical Neurosciences, , Addenbrooke’s Hospital and University of Cambridge, Cambridge Biomedical Campus, ; Cambridge, CB20QQ UK
                [21 ]GRID grid.11586.3b, ISNI 0000 0004 1767 8969, Department of Neurological Sciences, , Christian Medical College, ; Ida Scudder Road, Vellore, Tamil Nadu India
                [22 ]Vivian L Smith Department of Neurosurgery, McGovern Medical School at UTHealth, 6400 Fannin St, Suite 2800, Houston, TX 77030 USA
                [23 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, University of California San Francisco, San Francisco General Hospital and Trauma Center, ; 1001 Potrero Ave., Bldg 1, Room 101, San Francisco, CA 94110 USA
                [24 ]GRID grid.413103.4, ISNI 0000 0001 2160 8953, Neurology, K-11, , Henry Ford Hospital, ; 2799 W Grand Blvd, Detroit, MI 48202 USA
                [25 ]GRID grid.5335.0, ISNI 0000000121885934, Division of Anaesthesia, , University of Cambridge and Addenbrooke’s Hospital, ; Addenbrooke’s Hospital, Hills Road, Box 93, Cambridge, CB2 0QQ UK
                [26 ]GRID grid.410569.f, ISNI 0000 0004 0626 3338, Department and Laboratory of Intensive Care Medicine, , University Hospitals Leuven and KU Leuven, ; Herestraat 49, Box 7003 63, 3000 Leuven, Belgium
                [27 ]GRID grid.489098.4, ISNI 0000 0004 5913 0862, Oakland University William Beaumont School of Medicine, Beaumont Health, Michigan Head and Spine Institute, ; Southfield, MI USA
                [28 ]GRID grid.9851.5, ISNI 0000 0001 2165 4204, Department of Intensive Care Medicine, , CHUV-Lausanne University Hospital, University of Lausanne, Faculty of Biology and Medicine, ; Lausanne, Switzerland
                [29 ]GRID grid.412689.0, ISNI 0000 0001 0650 7433, Department of Neurosurgery, , University of Pittsburgh Medical Center, ; Pittsburgh, PA USA
                [30 ]GRID grid.412807.8, ISNI 0000 0004 1936 9916, Vanderbilt University Medical Center, ; Nashville, USA
                [31 ]GRID grid.39382.33, ISNI 0000 0001 2160 926X, Baylor College of Medicine, ; One Baylor Plaza, Houston, TX 77030 USA
                [32 ]GRID grid.1623.6, ISNI 0000 0004 0432 511X, Department of Neurosurgery, , Alfred Hospital, ; Melbourne, Australia
                [33 ]GRID grid.1002.3, ISNI 0000 0004 1936 7857, Department of Surgery, , Monash University, ; Melbourne, Australia
                [34 ]GRID grid.412195.a, ISNI 0000 0004 1761 4447, INUB/MEDITECH Research Group, Neurosciences Institute, , El Bosque University, ; Bogotá, Colombia
                [35 ]MEDITECH Foundation, Clinical Research, Calle 7-A # 44-95, 760036 Cali, Colombia
                [36 ]GRID grid.411083.f, ISNI 0000 0001 0675 8654, University Hospital Vall D’Hebron, ; Barcelona, Spain
                [37 ]Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
                [38 ]World Federation of Neurosurgical Societies, Nyon, Switzerland
                [39 ]GRID grid.412689.0, ISNI 0000 0001 0650 7433, University of Pittsburgh Medical Center, ; 3550 Terrace St, Room 646, Pittsburgh, PA 15261 USA
                [40 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, ; 1001 Potrero Ave., Ward 3A, San Francisco, CA 94110 USA
                [41 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Department of Physiopathology and Transplantation, , Milan University, ; Milan, Italy
                [42 ]GRID grid.414818.0, ISNI 0000 0004 1757 8749, Neuroscience Intensive Care Unit, , Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, ; Milan, Italy
                [43 ]GRID grid.4989.c, ISNI 0000 0001 2348 0746, Department of Intensive Care, Hospital Erasme, , Université Libre de Bruxelles (ULB), ; Brussels, Belgium
                [44 ]GRID grid.240473.6, ISNI 0000 0004 0543 9901, Department of Neurological Surgery, , Penn State University Milton S. Hershey Medical Center, ; 30 Hope Dr., Suite 1200 | Building B, Hershey, PA 17033 USA
                [45 ]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
                [46 ]GRID grid.240382.f, ISNI 0000 0001 0490 6107, 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
                [47 ]GRID grid.415228.8, Ronald Reagan UCLA Medical Center, UCLA Medical Center, Santa Monica, ; Santa Monica, USA
                [48 ]Posadas Hospital, Buenos Aires, Argentina
                [49 ]GRID grid.189967.8, ISNI 0000 0001 0941 6502, Emory University School of Medicine, ; 49 Jesse Hill Jr Dr, Atlanta, GA 30303 USA
                [50 ]GRID grid.412750.5, ISNI 0000 0004 1936 9166, School of Medicine and Dentistry, , University of Rochester Medical Center, ; 601 Elmwood Ave, Box 655C, Rochester, NY 14642 USA
                [51 ]GRID grid.21613.37, ISNI 0000 0004 1936 9609, Section of Neurosurgery, , University of Manitoba, ; GB1, 820 Sherbrook Street, Winnipeg, MB R3A 1R9 Canada
                Author information
                http://orcid.org/0000-0001-6377-3666
                http://orcid.org/0000-0002-5604-7057
                Article
                5900
                10.1007/s00134-019-05900-x
                7210240
                31965267
                28c99ac7-caf0-4d0e-83a7-ca65a7ab45ce
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 16 November 2019
                : 14 December 2019
                Categories
                Conference Reports and Expert Panel
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                Emergency medicine & Trauma
                brain injury,head trauma,algorithm,protocol,consensus,intracranial pressure,brain oxygen,tiers,seattle,sibicc,pbto2

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