A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)
A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)
复制标题
DOI：
10.1007/s00134-019-05900-x
复制
发表时间：
2020-05-01
影响因子：
38.9
通讯作者：
Hawryluk, Gregory W. J.
中科院分区：
文献类型：
--
作者：
Chesnut, Randall;Aguilera, Sergio;Hawryluk, Gregory W. J.
背景 目前成人严重创伤性脑损伤 (sTBI) 的治疗指南包含高质量的证据报告，但不再附有管理方案，因为这些方案需要专家意见来弥合已发表的证据和患者护理之间的差距。我们的目标是为配备颅内压 (ICP) 和脑氧监测仪的成年患者建立现代 sTBI 方案。方法 我们的共识工作组由来自六大洲的 42 位经验丰富且积极实践 sTBI 意见领袖组成。我们之前制定了单独 ICP 监测患者的治疗方案，现在我们针对除 ICP 监测仪外还配有脑氧监测仪的患者进行治疗。管理协议是通过基于德尔菲法的共识方法制定的，并在现场会议上最终确定。结果我们建立了三种不同的治疗方案，每种方案都有三层，其中更高层涉及风险更高的治疗。一项协议解决了脑氧合正常时 ICP 升高的管理。第二个解决了正常 ICP 下脑缺氧的管理问题。第三个方案解决了同时存在颅内高压和脑缺氧的情况。该小组在设计不同算法时考虑了与输血和呼吸机管理有关的问题。结论 这些方案旨在帮助临床医生管理 ICP 和脑氧监测仪的患者，但它们既不能反映护理标准，也不能替代周到的个体化管理。这些方案应与最近与西雅图国际脑损伤共识会议一起发布的基本护理、严重神经恶化的管理和断奶治疗的建议结合使用。
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.