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A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC).
- Hawryluk, Gregory WJ;
- Aguilera, Sergio;
- Buki, Andras;
- Bulger, Eileen;
- Citerio, Giuseppe;
- Cooper, D Jamie;
- Arrastia, Ramon Diaz;
- Diringer, Michael;
- Figaji, Anthony;
- Gao, Guoyi;
- Geocadin, Romergryko;
- Ghajar, Jamshid;
- Harris, Odette;
- Hoffer, Alan;
- Hutchinson, Peter;
- Joseph, Mathew;
- Kitagawa, Ryan;
- Manley, Geoffrey;
- Mayer, Stephan;
- Menon, David K;
- Meyfroidt, Geert;
- Michael, Daniel B;
- Oddo, Mauro;
- Okonkwo, David;
- Patel, Mayur;
- Robertson, Claudia;
- Rosenfeld, Jeffrey V;
- Rubiano, Andres M;
- Sahuquillo, Juan;
- Servadei, Franco;
- Shutter, Lori;
- Stein, Deborah;
- Stocchetti, Nino;
- Taccone, Fabio Silvio;
- Timmons, Shelly;
- Tsai, Eve;
- Ullman, Jamie S;
- Vespa, Paul;
- Videtta, Walter;
- Wright, David W;
- Zammit, Christopher;
- Chesnut, Randall M
Abstract
Background
Management algorithms for adult severe traumatic brain injury (sTBI) were omitted in later editions of the Brain Trauma Foundation's sTBI Management Guidelines, as they were not evidence-based.Methods
We used a Delphi-method-based consensus approach to address management of sTBI patients undergoing intracranial pressure (ICP) monitoring. Forty-two experienced, clinically active sTBI specialists from six continents comprised the panel. Eight surveys iterated queries and comments. An in-person meeting included whole- and small-group discussions and blinded voting. Consensus required 80% agreement. We developed heatmaps based on a traffic-light model where panelists' decision tendencies were the focus of recommendations.Results
We provide comprehensive algorithms for ICP-monitor-based adult sTBI management. Consensus established 18 interventions as fundamental and ten treatments not to be used. We provide a three-tier algorithm for treating elevated ICP. Treatments within a tier are considered empirically equivalent. Higher tiers involve higher risk therapies. Tiers 1, 2, and 3 include 10, 4, and 3 interventions, respectively. We include inter-tier considerations, and recommendations for critical neuroworsening to assist the recognition and treatment of declining patients. Novel elements include guidance for autoregulation-based ICP treatment based on MAP Challenge results, and two heatmaps to guide (1) ICP-monitor removal and (2) consideration of sedation holidays for neurological examination.Conclusions
Our modern and comprehensive sTBI-management protocol is designed to assist clinicians managing sTBI patients monitored with ICP-monitors alone. Consensus-based (class III evidence), it provides management recommendations based on combined expert opinion. It reflects neither a standard-of-care nor a substitute for thoughtful individualized management.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.
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