Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations

被引：7

作者：

Chesnut, Randall M. ^{[1
,3
,4
]}

Aguilera, Sergio ^{[5
]}

Buki, Andras ^{[6
]}

Bulger, Eileen M. ^{[2
,7
]}

Citerio, Giuseppe ^{[8
,9
]}

Cooper, D. Jamie ^{[10
,11
]}

Arrastia, Ramon Diaz ^{[12
]}

Diringer, Michael ^{[13
,14
]}

Figaji, Anthony ^{[15
]}

Gao, Guoyi

Geocadin, Romergryko G. ^{[17
]}

Ghajar, Jamshid ^{[18
,19
]}

Harris, Odette ^{[20
]}

Hawryluk, Gregory W. J. ^{[21
,22
,23
,28
]}

Hoffer, Alan ^{[16
,24
,31
,32
]}

Hutchinson, Peter ^{[25
]}

Joseph, Mathew ^{[26
]}

Kitagawa, Ryan ^{[27
]}

Manley, Geoffrey ^{[29
]}

Mayer, Stephan ^{[30
]}

Menon, David K.

Meyfroidt, Geert

Michael, Daniel B. ^{[35
]}

Oddo, Mauro

Okonkwo, David O. ^{[38
,45
,46
]}

Patel, Mayur B. ^{[39
,47
,48
]}

Robertson, Claudia ^{[40
]}

Rosenfeld, Jeffrey V. ^{[33
,34
,41
,50
]}

Rubiano, Andres M. ^{[35
,36
,37
]}

Sahuquillo, Juain ^{[45
,46
]}

Servadei, Franco ^{[47
,48
]}

Shutter, Lori ^{[49
]}

Stein, Deborah M.

Stocchetti, Nino ^{[33
,34
,35
,42
,43
,51
,52
]}

Taccone, Fabio Silvio ^{[44
,53
]}

Timmons, Shelly D. ^{[54
]}

Tsai, Eve C. ^{[47
,48
,55
]}

Ullman, Jamie S. ^{[56
]}

Videtta, Walter ^{[57
]}

Wright, David W. ^{[33
,34
,58
]}

Zammit, Christopher ^{[35
,59
]}

机构：

[1] Univ Washington, Dept Neurol Surg, Seattle, WA USA

[2] Univ Washington, Dept Orthopaed Surg, Seattle, WA USA

[3] Univ Washington, Harborview Med Ctr, Seattle, WA USA

[4] Valparaiso Univ, Almirante Nef Naval Hosp, Vina Del Mar, Chile

[5] Univ Valparaiso, Valparaiso, Chile

[6] Orebro Univ, Fac Med & Hlth, Dept Neurosurg, Orebro, Sweden

[7] Univ Washington, Dept Surg, Harborview Med Ctr, Seattle, WA USA

[8] Univ Milano Bicocca, Sch Med & Surg, Milan, Italy

[9] Fdn IRCCS San Gerardo Tintori, Neurosci Dept, NeuroIntens Care Unit, Monza, Italy

[10] Monash Univ, Australian & New Zealand Intens Care Res Ctr, Intens Care Med, Melbourne, Vic, Australia

[11] Alfred Hosp, Dept Intens Care & Hyperbar Med, Melbourne, Vic, Australia

[12] Univ Pennsylvania, Dept Neurol, Penn Presbyterian Med Ctr, Perelman Sch Med, Philadelphia, PA USA

[13] Washington Univ, Dept Neurol, Sch Med, St Louis, MO USA

[14] Barnes Jewish Hosp, Dept Neurol, St Louis, MO USA

[15] Univ Cape Town, Groote Schuur Hosp, Div Neurosurg & Neurosci Inst, ZA-7925 Observatory, South Africa

[16] Shanghai Jiao Tong Univ, Shanghai Inst Head Trauma, Renji Hosp, Dept Neurosurg,Sch Med, Shanghai, Peoples R China

[17] Johns Hopkins Univ, Dept Neurol, Neurol Surg, Anesthesiol Crit Care Med,Sch Med, Baltimore, MD USA

[18] Johns Hopkins Univ, Dept Neurol Surg Anesthesiol Crit Care Med, Sch Med, Baltimore, MD USA

[19] Stanford Neurosci Hlth Ctr, Dept Neurosurg, Palo Alto, CA USA

[20] Stanford Univ, Dept Neurosurg, Ctr Acad Med, Sch Med, Stanford, CA USA

[21] Cleveland Clin, Akron Gen Neurosci Ctr, Fairlawn, OH USA

[22] Uniformed Serv Univ Hlth Sci, Bethesda, MD USA

[23] Brain Trauma Fdn, New York, NY USA

[24] UH Cleveland Med Ctr, Cleveland, OH USA

[25] Univ Cambridge, Addenbrookes Hosp, Div Neurosurg, Dept Clin Neurosci, Cambridge, England

[26] Christian Med Coll & Hosp, Dept Neurol Sci, Vellore, Tamil Nadu, India

[27] UTHlth, McGovern Med Sch, Vivian L Smith Dept Neurosurg, Houston, TX USA

[28] Univ Calif San Francisco, Dept Neurol Surg, San Francisco, CA USA

[29] Zuckerberg San Francisco Gen Hosp & Trauma Ctr, Dept Neurosurg, San Francisco, CA USA

[30] New York Med Coll, Westchester Hlth Network, Valhalla, NY USA

[31] Univ Cambridge, Addenbrookes Hosp, Div Anaesthesia, Cambridge, England

[32] Addenbrookes Hosp, Cambridge, England

[33] Univ Hosp Leuven, Dept Intens Care Med, Leuven, Belgium

[34] Katholieke Univ Leuven, Dept Cellular & Mol Med, Lab Intens Care Med, Leuven, Belgium

[35] Oakland Univ, Dept Neurosurg, Beaumont Hlth, Michigan Head & Spine Inst,William Beaumont Sch M, Beaumont, MI USA

[36] Univ Lausanne, CHUV Med Directorate, Lausanne, Switzerland

[37] Univ Lausanne, Fac Biol & Med, Lausanne, Switzerland

[38] Univ Pittsburgh Med Ctr Presbyterian, Dept Neurosurg, Pittsburgh, PA USA

[39] Vanderbilt Univ, Div Acute Care Surg, Dept Surg, Med Ctr, Nashville, TN USA

[40] Baylor Coll Med, Dept Neurosurg, 1 Baylor Plaza, Houston, TX USA

[41] Alfred Hosp, Dept Neurosurg, Melbourne, Australia

[42] Monash Univ, Dept Surg, Melbourne, Australia

[43] El Bosque Univ, Neurosci Inst, INUB MEDITECH Res Grp, Bogota, Colombia

[44] MEDITECH Fdn, Clin Res, Cali, Colombia

[45] Univ Autonoma Barcelona, Vall Hebron Univ Hosp, Dept Neurosurg, Barcelona, Spain

[46] Vall Hebron Inst Recerca VHIR, Neurotraumatol & Neurosurg Res Unit UNINN, Barcelona, Spain

[47] Humanitas Univ, Dept Biomed Sci, Milan, Italy

[48] IRCCS Humanitas Res Hosp, Milan, Italy

[49] Univ Pittsburgh, Dept Crit Care Med Neurol & Neurosurg, Med Ctr, Pittsburgh, PA USA

[50] Univ Maryland, Med Ctr, Adult Crit Care Serv, Sch Med, Baltimore, MD USA

来源：

NEUROSURGERY | 2023年 / 93卷 / 02期

基金：

英国医学研究理事会;

关键词：

Algorithms; Consensus development; Intracranial hypertension; Intracranial pressure monitoring; Neurocritical care; Practice guidelines; Traumatic brain injury; SEVERE HEAD-INJURY; MANAGEMENT; COMA; HYPERTENSION; IMPROVEMENT; GUIDELINES; CARE;

D O I：

10.1227/neu.0000000000002516

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND:Intracranial pressure (ICP) monitoring is widely practiced, but the indications are incompletely developed, and guidelines are poorly followed.OBJECTIVE:To study the monitoring practices of an established expert panel (the clinical working group from the Seattle International Brain Injury Consensus Conference effort) to examine the match between monitoring guidelines and their clinical decision-making and offer guidance for clinicians considering monitor insertion.METHODS:We polled the 42 Seattle International Brain Injury Consensus Conference panel members' ICP monitoring decisions for virtual patients, using matrices of presenting signs (Glasgow Coma Scale [GCS] total or GCS motor, pupillary examination, and computed tomography diagnosis). Monitor insertion decisions were yes, no, or unsure (traffic light approach). We analyzed their responses for weighting of the presenting signs in decision-making using univariate regression.RESULTS:Heatmaps constructed from the choices of 41 panel members revealed wider ICP monitor use than predicted by guidelines. Clinical examination (GCS) was by far the most important characteristic and differed from guidelines in being nonlinear. The modified Marshall computed tomography classification was second and pupils third. We constructed a heatmap and listed the main clinical determinants representing 80% ICP monitor insertion consensus for our recommendations.CONCLUSION:Candidacy for ICP monitoring exceeds published indicators for monitor insertion, suggesting the clinical perception that the value of ICP data is greater than simply detecting and monitoring severe intracranial hypertension. Monitor insertion heatmaps are offered as potential guidance for ICP monitor insertion and to stimulate research into what actually drives monitor insertion in unconstrained, real-world conditions.

引用

页码：399 / 408

页数：10

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