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

Intensive Care Med, 2019 · DOI: https://doi.org/10.1007/s00134-019-05805-9 · Published: October 28, 2019

Simple Explanation

This paper addresses the lack of evidence-based management algorithms for severe traumatic brain injury (sTBI). It uses a consensus approach to develop an algorithm for sTBI management in ICU patients with intracranial pressure (ICP) monitors. The consensus working group established fundamental interventions, treatments to avoid, and a three-tier algorithm for treating elevated ICP. Higher tiers involve therapies with higher risk, and the algorithm includes guidance for autoregulation-based ICP treatment. Heatmaps are provided to guide ICP-monitor removal and sedation holidays for neurological examination. The goal is to assist clinicians in managing sTBI patients with ICP-monitors, acknowledging that the recommendations are consensus-based and not a substitute for clinical judgment.

Study Duration

Not specified

Participants

42 experienced sTBI specialists

Evidence Level

Class III evidence

Key Findings

1
Consensus established 18 interventions as fundamental for sTBI care and ten treatments not to be used except in special circumstances.
2
A three-tier algorithm was developed for treating elevated ICP, with tiers representing increasing risk and intensity of interventions.
3
Heatmaps were created to guide decisions regarding ICP-monitor removal and the use of sedation holidays for neurological examinations.

Research Summary

The study addresses the absence of evidence-based algorithms for managing severe traumatic brain injury (sTBI) by developing a consensus-based algorithm for patients undergoing intracranial pressure (ICP) monitoring. The consensus working group (CWG) identified fundamental interventions, treatments to avoid, and created a three-tier algorithm for managing elevated ICP, with higher tiers involving higher-risk therapies. The study provides inter-tier recommendations, guidance on critical neuroworsening, and heatmaps to assist in decisions about ICP-monitor removal and sedation holidays, emphasizing that these are consensus-based recommendations and not a substitute for clinical judgment.

Practical Implications

Clinical Guidance

Provides clinicians, especially those in non-specialist centers, with a structured approach to managing sTBI patients with ICP monitors.

Decision Support

Offers heatmaps to aid in decisions about ICP monitor removal and sedation holidays, promoting safer and more informed clinical practice.

Future Research

Highlights areas where further research is needed to increase the rigor and efficacy of sTBI management algorithms.

Study Limitations

1
The algorithm is based on expert consensus (class III evidence) and not on high-quality evidence from randomized controlled trials.
2
The recommendations primarily focus on ICP control and short-term clinical outcomes, lacking rigorous control of conditions and outcomes.
3
The findings may be influenced by personal biases, technical idiosyncrasies, and the specific care environment of the expert practitioners.

Your Feedback

Was this summary helpful?

Back to Healthcare