Variation in general supportive and preventive intensive care management of traumatic brain injury: a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study.
[en] BACKGROUND: General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. METHODS: We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We analyzed 23 questions focused on: 1) circulatory and respiratory management; 2) fever control; 3) use of corticosteroids; 4) nutrition and glucose management; and 5) seizure prophylaxis and treatment. RESULTS: The survey was completed predominantly by intensivists (n = 33, 50%) and neurosurgeons (n = 23, 35%) from 66 centers (97% response rate). The most common cerebral perfusion pressure (CPP) target was > 60 mmHg (n = 39, 60%) and/or an individualized target (n = 25, 38%). To support CPP, crystalloid fluid loading (n = 60, 91%) was generally preferred over albumin (n = 15, 23%), and vasopressors (n = 63, 96%) over inotropes (n = 29, 44%). The most commonly reported target of partial pressure of carbon dioxide in arterial blood (PaCO2) was 36-40 mmHg (4.8-5.3 kPa) in case of controlled intracranial pressure (ICP) < 20 mmHg (n = 45, 69%) and PaCO2 target of 30-35 mmHg (4-4.7 kPa) in case of raised ICP (n = 40, 62%). Almost all respondents indicated to generally treat fever (n = 65, 98%) with paracetamol (n = 61, 92%) and/or external cooling (n = 49, 74%). Conventional glucose management (n = 43, 66%) was preferred over tight glycemic control (n = 18, 28%). More than half of the respondents indicated to aim for full caloric replacement within 7 days (n = 43, 66%) using enteral nutrition (n = 60, 92%). Indications for and duration of seizure prophylaxis varied, and levetiracetam was mostly reported as the agent of choice for both seizure prophylaxis (n = 32, 49%) and treatment (n = 40, 61%). CONCLUSIONS: Practice preferences vary substantially regarding general supportive and preventive measures in TBI patients at ICUs of European neurotrauma centers. These results provide an opportunity for future comparative effectiveness research, since a more evidence-based uniformity in good practices in general ICU management could have a major impact on TBI outcome.
Disciplines :
Neurology Surgery
Author, co-author :
Huijben, Jilske A.
Volovici, Victor
Cnossen, Maryse C.
Haitsma, Iain K.
Stocchetti, Nino
Maas, Andrew I. R.
Menon, David K.
Ercole, Ari
Citerio, Giuseppe
Nelson, David
Polinder, Suzanne
Steyerberg, Ewout W.
Lingsma, Hester Floor
van der Jagt, Mathieu
Adams, Hadie
Alessandro, Masala
Allanson, Judith
Amrein, Krisztina
Andaluz, Norberto
Andelic, Nada
Andrea, Nanni
Andreassen, Lasse
Anke, Audny
Antoni, Anna
Ardon, Hilko
Audibert, Gerard
Auslands, Kaspars
Azouvi, Philippe
Baciu, Camelia
Bacon, Andrew
Badenes, Rafael
Baglin, Trevor
Bartels, Ronald
Barzo, Pal
Bauerfeind, Ursula
Beer, Ronny
Belda, Javier Francisco
Bellander, Bo-Michael
Belli, Antonio
Bellier, Remy
Benali, Habib
Benard, Thierry
Berardino, Maurizio
Beretta, Luigi
Beynon, Christopher
Bilotta, Federico
Binder, Harald
Biqiri, Erta
Blaabjerg, Morten
Borgen, Stine Lund
Bouzat, Pierre
Bragge, Peter
Brazinova, Alexandra
Brehar, Felix
Brorsson, Camilla
Buki, Andras
Bullinger, Monika
Buckova, Veronika
Calappi, Emiliana
Cameron, Peter
Carbayo, Guillermo Lozano
Carise, Elsa
Carpenter, K.
Castano-Leon, Ana M.
Causin, Francesco
Chevallard, Giorgio
Chieregato, Arturo
Citerio, Giuseppe
Cnossen, Maryse
Coburn, Mark Coburn
Coles, Jonathan
Cooper, Jamie D.
Correia, Marta
Covic, Amra
Curry, Nicola
Czeiter, Endre
Czosnyka, Marek
Dahyot-Fizelier, Claire
Damas, François ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Damas, Pierre ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Dawes, Helen
De Keyser, Véronique ; Université de Liège - ULiège > Département de Psychologie > Département de Psychologie
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