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Crit Care. 2018 Apr 13;22(1):90. doi: 10.1186/s13054-018-2000-6.

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.

Collaborators (322)

Adams H, Alessandro M, Allanson J, Amrein K, Andaluz N, Andelic N, Andrea N, Andreassen L, Anke A, Antoni A, Ardon H, Audibert G, Auslands K, Azouvi P, Baciu C, Bacon A, Badenes R, Baglin T, Bartels R, Barzó P, Bauerfeind U, Beer R, Belda JF, Bellander BM, Belli A, Bellier R, Benali H, Benard T, Berardino M, Beretta L, Beynon C, Bilotta F, Binder H, Biqiri E, Blaabjerg M, Borgen SL, Bouzat P, Bragge P, Brazinova A, Brehar F, Brorsson C, Buki A, Bullinger M, Bučková V, Calappi E, Cameron P, Carbayo GL, Carise E, Carpenter K, Castaño-León AM, Causin F, Chevallard G, Chieregato A, Citerio G, Cnossen M, Coburn MC, Coles J, Cooper JD, Correia M, Covic A, Curry N, Czeiter E, Czosnyka M, Dahyot-Fizelier C, Damas F, Damas P, Dawes H, De Keyser V, Della FC, Depreitere B, Ding S, Dippel D, Dizdarevic K, Dulière LG, Dzeko A, Eapen G, Engemann H, Ercole A, Esser P, Ezer E, Fabricius M, Feigin VL, Feng J, Foks K, Fossi F, Francony G, Frantzén J, Freo U, Frisvold S, Furmanov A, Pablo G, Galanaud D, Gao G, Geleijns K, Ghuysen A, Giraud B, Glocker B, Gomez PA, Grossi F, Gruen RL, Gupta D, Haagsma JA, Hadzic E, Haitsma I, Hartings JA, Helbok R, Helseth E, Hertle D, Hill S, Hoedemaekers A, Hoefer S, Hutchinson PJ, Håberg AK, Jacobs B, Janciak I, Janssens K, Jiang JY, Jones K, Kalala JP, Kamnitsas K, Karan M, Karau J, Katila A, Kaukonen M, Keeling D, Kerforne T, Ketharanathan N, Kettunen J, Kivisaari R, Kolias AG, Kolumbán B, Kompanje E, Kondziella D, Koskinen LO, Kovács N, Kálovits F, Lagares A, Lanyon L, Laureys S, Lauritzen M, Lecky F, Ledig C, Lefering R, Legrand V, Lei J, Levi L, Lightfoot R, Lingsma H, Loeckx D, Lozano A, Luddington R, Luijten-Arts C, Maas AIR, MacDonald S, MacFayden C, Maegele M, Majdan M, Major S, Manara A, Manhes P, Manley G, Martin D, Martino C, Maruenda A, Maréchal H, Mastelova D, Mattern J, McMahon C, Melegh B, Menon D, Menovsky T, Morganti-Kossmann C, Mulazzi D, Mutschler M, Mühlan H, Negru A, Nelson D, Neugebauer E, Newcombe V, Noirhomme Q, Nyirádi J, Oddo M, Oldenbeuving A, Oresic M, Ortolano F, Palotie A, Parizel PM, Patruno A, Payen JF, Perera N, Perlbarg V, Persona P, Peul W, Pichon N, Piilgaard H, Piippo A, Pili SF, Pirinen M, Ples H, Polinder S, Pomposo I, Psota M, Pullens P, Puybasset L, Ragauskas A, Raj R, Rambadagalla M, Rehorčíková V, Rhodes J, Richardson S, Ripatti S, Rocka S, Rodier N, Roe C, Roise O, Roks G, Romegoux P, Rosand J, Rosenfeld J, Rosenlund C, Rosenthal G, Rossaint R, Rossi S, Rostalski T, Rueckert D, de Arcaute FR, Rusnák M, Sacchi M, Sahakian B, Sahuquillo J, Sakowitz O, Sala F, Sanchez-Pena P, Sanchez-Porras R, Sandor J, Santos E, Sasse N, Sasu L, Savo D, Schipper I, Schlößer B, Schmidt S, Schneider A, Schoechl H, Schoonman G, Schou FR, Schwendenwein E, Schöll M, Sir Ö, Skandsen T, Smakman L, Smeets D, Smielewski P, Sorinola A, Stamatakis E, Stanworth S, Stegemann K, Steinbüchel N, Stevens R, Stewart W, Steyerberg EW, Stocchetti N, Sundström N, Synnot A, Szabó J, Söderberg J, Taccone SF, Tamás V, Tanskanen P, Tascu A, Taylor MS, Te BA, Tenovuo O, Teodorani G, Theadom A, Thomas M, Tibboel D, Tolias C, Jean-Flory LT, Tudora MC, Vajkoczy P, Valeinis E, Van Hecke W, Van Praag D, Van Roost D, Van Vlierberghe E, Vyvere TV, Vanhaudenhuyse A, Vargiolu A, Vega E, Verheyden J, Vespa PM, Vik A, Vilcinis R, Vizzino G, Vleggeert-Lankamp C, Volovici V, Vulekovic P, Vámos Z, Wade D, Wang KKW, Wang L, Wildschut E, Williams G, Willumsen L, Wilson A, Wilson L, Winkler MKL, Ylén P, Younsi A, Zaaroor M, Zhang Z, Zheng Z, Zumbo F, de Lange S, de Ruiter GCW, den Boogert H, van Dijck J, van Essen TA, van Heugten C, van der Jagt M, van der Naalt J.

Author information

1
Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands. j.a.huijben@erasmusmc.nl.
2
Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.
3
Department of Neurosurgery, Office H-703, Erasmus MC Stroke Center and Brain Tumor Center, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
4
Department of Pathophysiology and Transplants, University of Milan, Milan, Italy.
5
Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Department of Anesthesia and Critical Care, Neuroscience Intensive Care Unit, Milan, Italy.
6
Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
7
Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
8
School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
9
Neurointensive Care, San Gerardo Hospital, ASST-Monza, Monza, Italy.
10
Section for Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
11
Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands.
12
Department of Intensive Care and Erasmus MC Stroke Center, Erasmus Medical Center, Rotterdam, the Netherlands.

Abstract

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.

KEYWORDS:

Blood pressure; Europe; Fever; Glucose; Intensive care unit; Nutrition; Seizure; Survey; Traumatic brain injury; Ventilation

PMID:
29650049
PMCID:
PMC5898014
DOI:
10.1186/s13054-018-2000-6
[Indexed for MEDLINE]
Free PMC Article

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