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2. A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC).

Author

Chesnut, Randall, Aguilera, Sergio, Buki, Andras, Bulger, Eileen, Citerio, Giuseppe, Cooper, D Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romer, 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, and Hawryluk, Gregory WJ

Subjects
Algorithm, Brain injury, Brain oxygen, Consensus, Head trauma, Intracranial pressure, PbtO2, Protocol, SIBICC, Seattle, Tiers, Emergency & Critical Care Medicine, Clinical Sciences, Public Health and Health Services
Abstract

BackgroundCurrent 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.MethodsOur 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.ResultsWe 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.ConclusionsThese 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.

Published
2020

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

Author

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, and Chesnut, Randall M

Subjects
Humans, Intracranial Hypertension, Monitoring, Physiologic, Algorithms, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Consensus Development Conferences as Topic, Practice Guidelines as Topic, Brain Injuries, Traumatic, Algorithm, Brain injury, Consensus, Head trauma, Intracranial pressure, Protocol, SIBICC, Seattle, Tiers, Traumatic Brain Injury (TBI), Neurosciences, Traumatic Head and Spine Injury, Brain Disorders, Physical Injury - Accidents and Adverse Effects, Clinical Sciences, Public Health and Health Services, Emergency & Critical Care Medicine
Abstract

BackgroundManagement 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.MethodsWe 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.ResultsWe 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.ConclusionsOur 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.

Published
2019

5. Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury

Author

Hutchinson, Peter J, Kolias, Angelos G, Tajsic, Tamara, Adeleye, Amos, Aklilu, Abenezer Tirsit, Apriawan, Tedy, Bajamal, Abdul Hafid, Barthélemy, Ernest J, Devi, B Indira, Bhat, Dhananjaya, Bulters, Diederik, Chesnut, Randall, Citerio, Giuseppe, Cooper, D Jamie, Czosnyka, Marek, Edem, Idara, El-Ghandour, Nasser MF, Figaji, Anthony, Fountas, Kostas N, Gallagher, Clare, Hawryluk, Gregory WJ, Iaccarino, Corrado, Joseph, Mathew, Khan, Tariq, Laeke, Tsegazeab, Levchenko, Oleg, Liu, Baiyun, Liu, Weiming, Maas, Andrew, Manley, Geoffrey T, Manson, Paul, Mazzeo, Anna T, Menon, David K, Michael, Daniel B, Muehlschlegel, Susanne, Okonkwo, David O, Park, Kee B, Rosenfeld, Jeffrey V, Rosseau, Gail, Rubiano, Andres M, Shabani, Hamisi K, Stocchetti, Nino, Timmons, Shelly D, Timofeev, Ivan, Uff, Chris, Ullman, Jamie S, Valadka, Alex, Waran, Vicknes, Wells, Adam, Wilson, Mark H, and Servadei, Franco

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Traumatic Brain Injury (TBI), Traumatic Head and Spine Injury, Neurosciences, Brain Disorders, Physical Injury - Accidents and Adverse Effects, Injuries and accidents, Good Health and Well Being, Brain Injuries, Traumatic, Consensus, Decompressive Craniectomy, Humans, Intracranial Hypertension, Neurosurgery, Neurotrauma, Decompression, Cranioplasty, Neurology & Neurosurgery, Clinical sciences
Abstract

BackgroundTwo randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach.MethodsThe International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries.ResultsThe invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval.ConclusionsIn this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.

Published
2019

6. Head Injury

Author

Unadkat, Prashin, Wagner, Katherine, Ullman, Jamie S., Figueiredo, Eberval Gadelha, editor, Welling, Leonardo C., editor, and Rabelo, Nícollas Nunes, editor

Published
2021
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11. Prognostication and Goals of Care Decisions in Severe Traumatic Brain Injury: A Survey of The Seattle International Severe Traumatic Brain Injury Consensus Conference Working Group

Author

Sarigul, Buse, primary, Bell, Randy S., additional, Chesnut, Randall, additional, Aguilera, Sergio, additional, Buki, Andras, additional, Citerio, Giuseppe, additional, Cooper, D. Jamie, additional, Diaz-Arrastia, Ramon, additional, Diringer, Michael, additional, Figaji, Anthony, additional, Gao, Guoyi, additional, Geocadin, Romergryko G., additional, Ghajar, Jamshid, additional, Harris, Odette, additional, Hoffer, Alan, additional, Hutchinson, Peter, additional, Joseph, Mathew, additional, Kitagawa, Ryan, additional, Manley, Geoffrey, additional, Mayer, Stephan A., additional, Menon, David K., additional, Meyfroidt, Geert, additional, Michael, Daniel B., additional, Oddo, Mauro, additional, Okonkwo, David O., additional, Patel, Mayur B., additional, Robertson, Claudia, additional, Rosenfeld, Jeffrey V., additional, Rubiano, Andres M., additional, Sahuquillo, Juan, additional, Servadei, Franco, additional, Shutter, Lori, additional, Stein, Deborah D., additional, Stocchetti, Nino, additional, Taccone, Fabio Silvio, additional, Timmons, Shelly D., additional, Tsai, Eve, additional, Ullman, Jamie S., additional, Vespa, Paul, additional, Videtta, Walter, additional, Wright, David W., additional, Zammit, Christopher, additional, and Hawryluk, Gregory W. J., additional

Published
2023
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13. Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations

Author

Chesnut, Randall M., primary, Aguilera, Sergio, additional, Buki, Andras, additional, Bulger, Eileen M., additional, Citerio, Giuseppe, additional, Cooper, D. Jamie, additional, Arrastia, Ramon Diaz, additional, Diringer, Michael, additional, Figaji, Anthony, additional, Gao, Guoyi, additional, Geocadin, Romergryko G., additional, Ghajar, Jamshid, additional, Harris, Odette, additional, Hawryluk, Gregory W. J., additional, Hoffer, Alan, additional, Hutchinson, Peter, additional, Joseph, Mathew, additional, Kitagawa, Ryan, additional, Manley, Geoffrey, additional, Mayer, Stephan, additional, Menon, David K, additional, Meyfroidt, Geert, additional, Michael, Daniel B., additional, Oddo, Mauro, additional, Okonkwo, David O., additional, Patel, Mayur B., additional, Robertson, Claudia, additional, Rosenfeld, Jeffrey V., additional, Rubiano, Andres M., additional, Sahuquillo, Juain, additional, Servadei, Franco, additional, Shutter, Lori, additional, Stein, Deborah M., additional, Stocchetti, Nino, additional, Taccone, Fabio Silvio, additional, Timmons, Shelly D., additional, Tsai, Eve C., additional, Ullman, Jamie S., additional, Videtta, Walter, additional, Wright, David W., additional, and Zammit, Christopher, additional

Published
2023
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14. Prognostication and Goals of Care Decisions in Severe Traumatic Brain Injury : A Survey of The Seattle International Severe Traumatic Brain Injury Consensus Conference Working Group

Author

Sarigul, Buse, Bell, Randy S., Chesnut, Randall, Aguilera, Sergio, Büki, Andras, Citerio, Giuseppe, Cooper, D. Jamie, Diaz-Arrastia, Ramon, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romergryko G., Ghajar, Jamshid, Harris, Odette, Hoffer, Alan, Hutchinson, Peter, Joseph, Mathew, Kitagawa, Ryan, Manley, Geoffrey, Mayer, Stephan A., Menon, David K., Meyfroidt, Geert, Michael, Daniel B., Oddo, Mauro, Okonkwo, David O., Patel, Mayur B., Robertson, Claudia, Rosenfeld, Jeffrey V., Rubiano, Andres M., Sahuquillo, Juan, Servadei, Franco, Shutter, Lori, Stein, Deborah D., Stocchetti, Nino, Taccone, Fabio Silvio, Timmons, Shelly D., Tsai, Eve, Ullman, Jamie S., Vespa, Paul, Videtta, Walter, Wright, David W., Zammit, Christopher, Hawryluk, Gregory W. J., Sarigul, Buse, Bell, Randy S., Chesnut, Randall, Aguilera, Sergio, Büki, Andras, Citerio, Giuseppe, Cooper, D. Jamie, Diaz-Arrastia, Ramon, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romergryko G., Ghajar, Jamshid, Harris, Odette, Hoffer, Alan, Hutchinson, Peter, Joseph, Mathew, Kitagawa, Ryan, Manley, Geoffrey, Mayer, Stephan A., Menon, David K., Meyfroidt, Geert, Michael, Daniel B., Oddo, Mauro, Okonkwo, David O., Patel, Mayur B., Robertson, Claudia, Rosenfeld, Jeffrey V., Rubiano, Andres M., Sahuquillo, Juan, Servadei, Franco, Shutter, Lori, Stein, Deborah D., Stocchetti, Nino, Taccone, Fabio Silvio, Timmons, Shelly D., Tsai, Eve, Ullman, Jamie S., Vespa, Paul, Videtta, Walter, Wright, David W., Zammit, Christopher, and Hawryluk, Gregory W. J.

Abstract

Best practice guidelines have advanced severe traumatic brain injury (TBI) care; however, there is little that currently informs goals of care decisions and processes despite their importance and frequency. Panelists from the Seattle International severe traumatic Brain Injury Consensus Conference (SIBICC) participated in a survey consisting of 24 questions. Questions queried use of prognostic calculators, variability in and responsibility for goals of care decisions, and acceptability of neurological outcomes, as well as putative means of improving decisions that might limit care. A total of 97.6% of the 42 SIBICC panelists completed the survey. Responses to most questions were highly variable. Overall, panelists reported infrequent use of prognostic calculators, and observed variability in patient prognostication and goals of care decisions. They felt that it would be beneficial for physicians to improve consensus on what constitutes an acceptable neurological outcome as well as what chance of achieving that outcome is acceptable. Panelists felt that the public should help to define what constitutes a good outcome and expressed some support for a "nihilism guard." More than 50% of panelists felt that if it was certain to be permanent, a vegetative state or lower severe disability would justify a withdrawal of care decision, whereas 15% felt that upper severe disability justified such a decision. Whether conceptualizing an ideal or existing prognostic calculator to predict death or an unacceptable outcome, on average a 64-69% chance of a poor outcome was felt to justify treatment withdrawal. These results demonstrate important variability in goals of care decision making and a desire to reduce this variability. Our panel of recognized TBI experts opined on the neurological outcomes and chances of those outcomes that might prompt consideration of care withdrawal; however, imprecision of prognostication and existing prognostication tools is a significant impediment t, Funding agencies:National Institute for Health Research (NIHR) Adler/Geirsch Attorney at Law American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Neurotrauma and Critical Care, Bard BrainTrauma Foundation DePuy Hemedex Integra Neurointensive Care Section of the European Society of Intensive Care Medicine Neurosurgical Society of Australasia Medtronic Moberg Research National University of Singapore Neuroptics Raumedic Sophysa Stryker Zoll

Published
2023
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15. Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury : A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations

Author

Chesnut, Randall M., Aguilera, Sergio, Buki, Andras, Bulger, Eileen M., Citerio, Giuseppe, Cooper, D. Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romergryko G., Ghajar, Jamshid, Harris, Odette, Hawryluk, Gregory W. J., Hoffer, Alan, Hutchinson, Peter, Joseph, Mathew, Kitagawa, Ryan, Manley, Geoffrey, Mayer, Stephan, Menon, David K., Meyfroidt, Geert, Michael, Daniel B., Oddo, Mauro, Okonkwo, David O., Patel, Mayur B., Robertson, Claudia, Rosenfeld, Jeffrey V., Rubiano, Andres M., Sahuquillo, Juain, Servadei, Franco, Shutter, Lori, Stein, Deborah M., Stocchetti, Nino, Taccone, Fabio Silvio, Timmons, Shelly D., Tsai, Eve C., Ullman, Jamie S., Videtta, Walter, Wright, David W., Zammit, Christopher, Chesnut, Randall M., Aguilera, Sergio, Buki, Andras, Bulger, Eileen M., Citerio, Giuseppe, Cooper, D. Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romergryko G., Ghajar, Jamshid, Harris, Odette, Hawryluk, Gregory W. J., Hoffer, Alan, Hutchinson, Peter, Joseph, Mathew, Kitagawa, Ryan, Manley, Geoffrey, Mayer, Stephan, Menon, David K., Meyfroidt, Geert, Michael, Daniel B., Oddo, Mauro, Okonkwo, David O., Patel, Mayur B., Robertson, Claudia, Rosenfeld, Jeffrey V., Rubiano, Andres M., Sahuquillo, Juain, Servadei, Franco, Shutter, Lori, Stein, Deborah M., Stocchetti, Nino, Taccone, Fabio Silvio, Timmons, Shelly D., Tsai, Eve C., Ullman, Jamie S., Videtta, Walter, Wright, David W., and Zammit, Christopher

Abstract

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.

Published
2023
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16. Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations

Author

Chesnut, R, Aguilera, S, Buki, A, Bulger, E, Citerio, G, Cooper, D, Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hawryluk, G, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Videtta, W, Wright, D, Zammit, C, Chesnut, Randall M, Aguilera, Sergio, Buki, Andras, Bulger, Eileen M, Citerio, Giuseppe, Cooper, D Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romergryko G, Ghajar, Jamshid, Harris, Odette, Hawryluk, Gregory W J, Hoffer, Alan, Hutchinson, Peter, Joseph, Mathew, Kitagawa, Ryan, Manley, Geoffrey, Mayer, Stephan, Menon, David K, Meyfroidt, Geert, Michael, Daniel B, Oddo, Mauro, Okonkwo, David O, Patel, Mayur B, Robertson, Claudia, Rosenfeld, Jeffrey V, Rubiano, Andres M, Sahuquillo, Juain, Servadei, Franco, Shutter, Lori, Stein, Deborah M, Stocchetti, Nino, Taccone, Fabio Silvio, Timmons, Shelly D, Tsai, Eve C, Ullman, Jamie S, Videtta, Walter, Wright, David W, Zammit, Christopher, Chesnut, R, Aguilera, S, Buki, A, Bulger, E, Citerio, G, Cooper, D, Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hawryluk, G, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Videtta, W, Wright, D, Zammit, C, Chesnut, Randall M, Aguilera, Sergio, Buki, Andras, Bulger, Eileen M, Citerio, Giuseppe, Cooper, D Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romergryko G, Ghajar, Jamshid, Harris, Odette, Hawryluk, Gregory W J, Hoffer, Alan, Hutchinson, Peter, Joseph, Mathew, Kitagawa, Ryan, Manley, Geoffrey, Mayer, Stephan, Menon, David K, Meyfroidt, Geert, Michael, Daniel B, Oddo, Mauro, Okonkwo, David O, Patel, Mayur B, Robertson, Claudia, Rosenfeld, Jeffrey V, Rubiano, Andres M, Sahuquillo, Juain, Servadei, Franco, Shutter, Lori, Stein, Deborah M, Stocchetti, Nino, Taccone, Fabio Silvio, Timmons, Shelly D, Tsai, Eve C, Ullman, Jamie S, Videtta, Walter, Wright, David W, and Zammit, Christopher

Abstract

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.

Published
2023

17. Prognostication and Withdrawal of Care Decisions in Severe Traumatic Brain Injury: A Survey of The Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC) Working Group

Author

Sarigul, B, Bell, R, Chesnut, R, Aguilera, S, Buki, A, Citerio, G, Cooper, D, Diaz-Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Vespa, P, Videtta, W, Wright, D, Zammit, C, Hawryluk, G, Sarigul, Buse, Bell, Randy S, Chesnut, Randall M, Aguilera, Sergio, Buki, Andras, Citerio, Giuseppe, Cooper, D James, Diaz-Arrastia, Ramon R, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romer, Ghajar, Jamshid, Harris, Odette A, Hoffer, Alan, Hutchinson, Peter John, Joseph, Matthew, Kitagawa, Ryan Seiji, Manley, Geoffrey T, Mayer, Stephan, Menon, David, Meyfroidt, Geert, Michael, Daniel, Oddo, Mauro, Okonkwo, David O, Patel, Mayur B, Robertson, Claudia S, Rosenfeld, Jeffrey V, Rubiano, Andres M, Sahuquillo, Juan, Servadei, Franco, Shutter, Lori, Stein, Deborah, Stocchetti, Nino, Taccone, Fabio, Timmons, Shelly, Tsai, Eve, Ullman, Jamie S, Vespa, Paul M, Videtta, Walter, Wright, David, Zammit, Christopher, Hawryluk, Gregory, Sarigul, B, Bell, R, Chesnut, R, Aguilera, S, Buki, A, Citerio, G, Cooper, D, Diaz-Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Vespa, P, Videtta, W, Wright, D, Zammit, C, Hawryluk, G, Sarigul, Buse, Bell, Randy S, Chesnut, Randall M, Aguilera, Sergio, Buki, Andras, Citerio, Giuseppe, Cooper, D James, Diaz-Arrastia, Ramon R, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romer, Ghajar, Jamshid, Harris, Odette A, Hoffer, Alan, Hutchinson, Peter John, Joseph, Matthew, Kitagawa, Ryan Seiji, Manley, Geoffrey T, Mayer, Stephan, Menon, David, Meyfroidt, Geert, Michael, Daniel, Oddo, Mauro, Okonkwo, David O, Patel, Mayur B, Robertson, Claudia S, Rosenfeld, Jeffrey V, Rubiano, Andres M, Sahuquillo, Juan, Servadei, Franco, Shutter, Lori, Stein, Deborah, Stocchetti, Nino, Taccone, Fabio, Timmons, Shelly, Tsai, Eve, Ullman, Jamie S, Vespa, Paul M, Videtta, Walter, Wright, David, Zammit, Christopher, and Hawryluk, Gregory

Abstract

Best practice guidelines have advanced severe traumatic brain injury (TBI) care; however, there is little that currently informs goals of care decisions and processes despite their importance and frequency. Panelists from the Seattle International severe traumatic Brain Injury Consensus Conference (SIBICC) participated in a survey consisting of 24 questions. Questions queried use of prognostic calculators, variability in and responsibility for goals of care decisions, and acceptability of neurological outcomes, as well as putative means of improving decisions that might limit care. A total of 97.6% of the 42 SIBICC panelists completed the survey. Responses to most questions were highly variable. Overall, panelists reported infrequent use of prognostic calculators, and observed variability in patient prognostication and goals of care decisions. They felt that it would be beneficial for physicians to improve consensus on what constitutes an acceptable neurological outcome as well as what chance of achieving that outcome is acceptable. Panelists felt that the public should help to define what constitutes a good outcome and expressed some support for a “nihilism guard.” More than 50% of panelists felt that if it was certain to be permanent, a vegetative state or lower severe disability would justify a withdrawal of care decision, whereas 15% felt that upper severe disability justified such a decision. Whether conceptualizing an ideal or existing prognostic calculator to predict death or an unacceptable outcome, on average a 64-69% chance of a poor outcome was felt to justify treatment withdrawal. These results demonstrate important variability in goals of care decision making and a desire to reduce this variability. Our panel of recognized TBI experts opined on the neurological outcomes and chances of those outcomes that might prompt consideration of care withdrawal; however, imprecision of prognostication and existing prognostication tools is a significant impediment t

Published
2023

19. International Survey of Antiseizure Medication Use in Patients with Complicated Mild Traumatic Brain Injury: A New York Neurotrauma Consortium Study

Author

Hickman, Zachary L., primary, Spielman, Lisa A., additional, Barthélemy, Ernest J., additional, Choudhri, Tanvir F., additional, Engelman, Brittany, additional, Giwa, Al O., additional, Greisman, Jacob D., additional, Margetis, Konstantinos, additional, Race, Meaghan, additional, Rahman, Jueria, additional, Todor, D. Roxanne, additional, Tsetsou, Spyridoula, additional, Ullman, Jamie S., additional, Unadkat, Prashin, additional, and Dams-O’Connor, Kristen, additional

Published
2022
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24. Pregnancy and parental leave among neurosurgeons and neurosurgical trainees

Author

Gupta, Mihir, primary, Reichl, Allison, additional, Diaz-Aguilar, Luis Daniel, additional, Duddleston, Pate J., additional, Ullman, Jamie S., additional, Muraszko, Karin M., additional, Timmons, Shelly D., additional, Germano, Isabelle M., additional, Abosch, Aviva, additional, Sweet, Jennifer A., additional, Pannullo, Susan C., additional, Benzil, Deborah L., additional, and Ben-Haim, Sharona, additional

Published
2021
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25. A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)

Author

Chesnut, R, Aguilera, S, Buki, A, Bulger, E, Citerio, G, Cooper, D, Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Vespa, P, Videtta, W, Wright, D, Zammit, C, Hawryluk, G, Chesnut, Randall, Aguilera, Sergio, Buki, Andras, Bulger, Eileen, Citerio, Giuseppe, Cooper, D Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romer, 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, Hawryluk, Gregory W J, Chesnut, R, Aguilera, S, Buki, A, Bulger, E, Citerio, G, Cooper, D, Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Vespa, P, Videtta, W, Wright, D, Zammit, C, Hawryluk, G, Chesnut, Randall, Aguilera, Sergio, Buki, Andras, Bulger, Eileen, Citerio, Giuseppe, Cooper, D Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romer, 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, and Hawryluk, Gregory W J

Abstract

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.

Published
2020

27. Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations

Author

Hawryluk, Gregory W J, primary, Rubiano, Andres M, additional, Totten, Annette M, additional, O’Reilly, Cindy, additional, Ullman, Jamie S, additional, Bratton, Susan L, additional, Chesnut, Randall, additional, Harris, Odette A, additional, Kissoon, Niranjan, additional, Shutter, Lori, additional, Tasker, Robert C, additional, Vavilala, Monica S, additional, Wilberger, Jack, additional, Wright, David W, additional, Lumba-Brown, Angela, additional, and Ghajar, Jamshid, additional

Published
2020
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28. Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury

Author

Hutchinson, Peter J., Kolias, Angelos G., Tajsic, Tamara, Adeleye, Amos, Aklilu, Abenezer Tirsit, Apriawan, Tedy, Bajamal, Abdul Hafid, Barthélemy, Ernest J., Devi, B. Indira, Bhat, Dhananjaya, Bulters, Diederik, Chesnut, Randall, Citerio, Giuseppe, Cooper, D. Jamie, Czosnyka, Marek, Edem, Idara, El-Ghandour, Nasser M.F., Figaji, Anthony, Fountas, Kostas N., Gallagher, Clare, Hawryluk, Gregory W.J., Iaccarino, Corrado, Joseph, Mathew, Khan, Tariq, Laeke, Tsegazeab, Levchenko, Oleg, Liu, Baiyun, Liu, Weiming, Maas, Andrew, Manley, Geoffrey T., Manson, Paul, Mazzeo, Anna T., Menon, David K., Michael, Daniel B., Muehlschlegel, Susanne, Okonkwo, David O., Park, Kee B., Rosenfeld, Jeffrey V., Rosseau, Gail, Rubiano, Andres M., Shabani, Hamisi K., Stocchetti, Nino, Timmons, Shelly D., Timofeev, Ivan, Uff, Chris, Ullman, Jamie S., Valadka, Alex, Waran, Vicknes, Wells, Adam, Wilson, Mark H., Servadei, Franco, and Apollo - University of Cambridge Repository

Subjects
Decompression, Decompressive Craniectomy, Consensus, Review Article - Conference Report, Brain Injuries, Traumatic, Neurosurgery, Humans, Intracranial Hypertension, Neurotrauma, Cranioplasty
Abstract

Background: Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. Methods: The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. Results: The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. Conclusions: In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.

Published
2019

29. Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury : Consensus statement.

Author

Hutchinson, Peter J, Hutchinson, Peter J, Kolias, Angelos G, Tajsic, Tamara, Adeleye, Amos, Aklilu, Abenezer Tirsit, Apriawan, Tedy, Bajamal, Abdul Hafid, Barthélemy, Ernest J, Devi, B Indira, Bhat, Dhananjaya, Bulters, Diederik, Chesnut, Randall, Citerio, Giuseppe, Cooper, D Jamie, Czosnyka, Marek, Edem, Idara, El-Ghandour, Nasser MF, Figaji, Anthony, Fountas, Kostas N, Gallagher, Clare, Hawryluk, Gregory WJ, Iaccarino, Corrado, Joseph, Mathew, Khan, Tariq, Laeke, Tsegazeab, Levchenko, Oleg, Liu, Baiyun, Liu, Weiming, Maas, Andrew, Manley, Geoffrey T, Manson, Paul, Mazzeo, Anna T, Menon, David K, Michael, Daniel B, Muehlschlegel, Susanne, Okonkwo, David O, Park, Kee B, Rosenfeld, Jeffrey V, Rosseau, Gail, Rubiano, Andres M, Shabani, Hamisi K, Stocchetti, Nino, Timmons, Shelly D, Timofeev, Ivan, Uff, Chris, Ullman, Jamie S, Valadka, Alex, Waran, Vicknes, Wells, Adam, Wilson, Mark H, Servadei, Franco, Hutchinson, Peter J, Hutchinson, Peter J, Kolias, Angelos G, Tajsic, Tamara, Adeleye, Amos, Aklilu, Abenezer Tirsit, Apriawan, Tedy, Bajamal, Abdul Hafid, Barthélemy, Ernest J, Devi, B Indira, Bhat, Dhananjaya, Bulters, Diederik, Chesnut, Randall, Citerio, Giuseppe, Cooper, D Jamie, Czosnyka, Marek, Edem, Idara, El-Ghandour, Nasser MF, Figaji, Anthony, Fountas, Kostas N, Gallagher, Clare, Hawryluk, Gregory WJ, Iaccarino, Corrado, Joseph, Mathew, Khan, Tariq, Laeke, Tsegazeab, Levchenko, Oleg, Liu, Baiyun, Liu, Weiming, Maas, Andrew, Manley, Geoffrey T, Manson, Paul, Mazzeo, Anna T, Menon, David K, Michael, Daniel B, Muehlschlegel, Susanne, Okonkwo, David O, Park, Kee B, Rosenfeld, Jeffrey V, Rosseau, Gail, Rubiano, Andres M, Shabani, Hamisi K, Stocchetti, Nino, Timmons, Shelly D, Timofeev, Ivan, Uff, Chris, Ullman, Jamie S, Valadka, Alex, Waran, Vicknes, Wells, Adam, Wilson, Mark H, and Servadei, Franco

Abstract

BackgroundTwo randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach.MethodsThe International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries.ResultsThe invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval.ConclusionsIn this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.

Published
2019

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

Author

Hawryluk, G, Aguilera, S, Buki, A, Bulger, E, Citerio, G, Cooper, D, Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Vespa, P, Videtta, W, Wright, D, Zammit, C, Chesnut, R, Hawryluk, Gregory W. J., 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., Hawryluk, G, Aguilera, S, Buki, A, Bulger, E, Citerio, G, Cooper, D, Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Vespa, P, Videtta, W, Wright, D, Zammit, C, Chesnut, R, Hawryluk, Gregory W. J., 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, and 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.

Published
2019

31. Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury: Consensus statement

Author

Hutchinson, P, Kolias, A, Tajsic, T, Adeleye, A, Aklilu, A, Apriawan, T, Bajamal, A, Barthélemy, E, Devi, B, Bhat, D, Bulters, D, Chesnut, R, Citerio, G, Cooper, D, Czosnyka, M, Edem, I, El-Ghandour, N, Figaji, A, Fountas, K, Gallagher, C, Hawryluk, G, Iaccarino, C, Joseph, M, Khan, T, Laeke, T, Levchenko, O, Liu, B, Liu, W, Maas, A, Manley, G, Manson, P, Mazzeo, A, Menon, D, Michael, D, Muehlschlegel, S, Okonkwo, D, Park, K, Rosenfeld, J, Rosseau, G, Rubiano, A, Shabani, H, Stocchetti, N, Timmons, S, Timofeev, I, Uff, C, Ullman, J, Valadka, A, Waran, V, Wells, A, Wilson, M, Servadei, F, Hutchinson, Peter J, Kolias, Angelos G, Tajsic, Tamara, Adeleye, Amos, Aklilu, Abenezer Tirsit, Apriawan, Tedy, Bajamal, Abdul Hafid, Barthélemy, Ernest J, Devi, B Indira, Bhat, Dhananjaya, Bulters, Diederik, Chesnut, Randall, Citerio, Giuseppe, Cooper, D Jamie, Czosnyka, Marek, Edem, Idara, El-Ghandour, Nasser M F, Figaji, Anthony, Fountas, Kostas N, Gallagher, Clare, Hawryluk, Gregory W J, Iaccarino, Corrado, Joseph, Mathew, Khan, Tariq, Laeke, Tsegazeab, Levchenko, Oleg, Liu, Baiyun, Liu, Weiming, Maas, Andrew, Manley, Geoffrey T, Manson, Paul, Mazzeo, Anna T, Menon, David K, Michael, Daniel B, Muehlschlegel, Susanne, Okonkwo, David O, Park, Kee B, Rosenfeld, Jeffrey V, Rosseau, Gail, Rubiano, Andres M, Shabani, Hamisi K, Stocchetti, Nino, Timmons, Shelly D, Timofeev, Ivan, Uff, Chris, Ullman, Jamie S, Valadka, Alex, Waran, Vicknes, Wells, Adam, Wilson, Mark H, Servadei, Franco, Hutchinson, P, Kolias, A, Tajsic, T, Adeleye, A, Aklilu, A, Apriawan, T, Bajamal, A, Barthélemy, E, Devi, B, Bhat, D, Bulters, D, Chesnut, R, Citerio, G, Cooper, D, Czosnyka, M, Edem, I, El-Ghandour, N, Figaji, A, Fountas, K, Gallagher, C, Hawryluk, G, Iaccarino, C, Joseph, M, Khan, T, Laeke, T, Levchenko, O, Liu, B, Liu, W, Maas, A, Manley, G, Manson, P, Mazzeo, A, Menon, D, Michael, D, Muehlschlegel, S, Okonkwo, D, Park, K, Rosenfeld, J, Rosseau, G, Rubiano, A, Shabani, H, Stocchetti, N, Timmons, S, Timofeev, I, Uff, C, Ullman, J, Valadka, A, Waran, V, Wells, A, Wilson, M, Servadei, F, Hutchinson, Peter J, Kolias, Angelos G, Tajsic, Tamara, Adeleye, Amos, Aklilu, Abenezer Tirsit, Apriawan, Tedy, Bajamal, Abdul Hafid, Barthélemy, Ernest J, Devi, B Indira, Bhat, Dhananjaya, Bulters, Diederik, Chesnut, Randall, Citerio, Giuseppe, Cooper, D Jamie, Czosnyka, Marek, Edem, Idara, El-Ghandour, Nasser M F, Figaji, Anthony, Fountas, Kostas N, Gallagher, Clare, Hawryluk, Gregory W J, Iaccarino, Corrado, Joseph, Mathew, Khan, Tariq, Laeke, Tsegazeab, Levchenko, Oleg, Liu, Baiyun, Liu, Weiming, Maas, Andrew, Manley, Geoffrey T, Manson, Paul, Mazzeo, Anna T, Menon, David K, Michael, Daniel B, Muehlschlegel, Susanne, Okonkwo, David O, Park, Kee B, Rosenfeld, Jeffrey V, Rosseau, Gail, Rubiano, Andres M, Shabani, Hamisi K, Stocchetti, Nino, Timmons, Shelly D, Timofeev, Ivan, Uff, Chris, Ullman, Jamie S, Valadka, Alex, Waran, Vicknes, Wells, Adam, Wilson, Mark H, and Servadei, Franco

Abstract

Background: Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. Methods: The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. Results: The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. Conclusions: In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.

Published
2019

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

Author

Hawryluk, Gregory W. J., Aguilera, Sergio, Büki, 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., Hawryluk, Gregory W. J., Aguilera, Sergio, Büki, 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, and 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., Funding Agencies:National Institutes of Health Research (NIHR) American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Neurotrauma and Critical Care, Bard Brain Trauma Foundation DePuy Hemedex Integra Neurointensive Care Section of the European Society of Intensive Care Medicine Neurosurgical Society of Australasia Medtronic Moberg Research National University of Singapore NeuropticsRaumedicSophysaStrykerZollNIHR (Cambridge BRC) NIHR (Global Health Research Group on Neurotrauma)

Published
2019
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35. Trauma

Author

Wagner, Katherine E, primary, Binyamin, Tamar R, additional, Colley, Patrick, additional, Chiluwal, Amrit K, additional, Harrop, James S, additional, Hawryluk, Gregory W, additional, Hickman, Zachary L, additional, Margetis, Konstantinos, additional, Rymarczuk, George N, additional, Stippler, Martina, additional, and Ullman, Jamie S, additional

Published
2019
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38. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition

Author

Carney, Nancy, primary, Totten, Annette M., additional, O'Reilly, Cindy, additional, Ullman, Jamie S., additional, Hawryluk, Gregory W.J., additional, Bell, Michael J., additional, Bratton, Susan L., additional, Chesnut, Randall, additional, Harris, Odette A., additional, Kissoon, Niranjan, additional, Rubiano, Andres M., additional, Shutter, Lori, additional, Tasker, Robert C., additional, Vavilala, Monica S., additional, Wilberger, Jack, additional, Wright, David W., additional, and Ghajar, Jamshid, additional

Published
2016
Full Text
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39. Trauma

Author

Steinberger, Jeremy M., primary, Pain, Margaret, additional, and Ullman, Jamie S., additional

Published
2016
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42. IV. Infection Prophylaxis

Author

Bratton, Susan L., primary, Chestnut, Randall M., additional, Ghajar, Jamshid, additional, McConnell Hammond, Flora F., additional, Harris, Odette A., additional, Hartl, Roger, additional, Manley, Geoffrey T., additional, Nemecek, Andrew, additional, Newell, David W., additional, Rosenthal, Guy, additional, Schouten, Joost, additional, Shutter, Lori, additional, Timmons, Shelly D., additional, Ullman, Jamie S., additional, Videtta, Walter, additional, Wilberger, Jack E., additional, and Wright, David W., additional

Published
2007
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43. X. Brain Oxygen Monitoring and Thresholds

Author

Bratton, Susan L., primary, Chestnut, Randall M., additional, Ghajar, Jamshid, additional, McConnell Hammond, Flora F., additional, Harris, Odette A., additional, Hartl, Roger, additional, Manley, Geoffrey T., additional, Nemecek, Andrew, additional, Newell, David W., additional, Rosenthal, Guy, additional, Schouten, Joost, additional, Shutter, Lori, additional, Timmons, Shelly D., additional, Ullman, Jamie S., additional, Videtta, Walter, additional, Wilberger, Jack E., additional, and Wright, David W., additional

Published
2007
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44. VII. Intracranial Pressure Monitoring Technology

Author

Bratton, Susan L., primary, Chestnut, Randall M., additional, Ghajar, Jamshid, additional, McConnell Hammond, Flora F., additional, Harris, Odette A., additional, Hartl, Roger, additional, Manley, Geoffrey T., additional, Nemecek, Andrew, additional, Newell, David W., additional, Rosenthal, Guy, additional, Schouten, Joost, additional, Shutter, Lori, additional, Timmons, Shelly D., additional, Ullman, Jamie S., additional, Videtta, Walter, additional, Wilberger, Jack E., additional, and Wright, David W., additional

Published
2007
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45. XII. Nutrition

Author

Bratton, Susan L., primary, Chestnut, Randall M., additional, Ghajar, Jamshid, additional, McConnell Hammond, Flora F., additional, Harris, Odette A., additional, Hartl, Roger, additional, Manley, Geoffrey T., additional, Nemecek, Andrew, additional, Newell, David W., additional, Rosenthal, Guy, additional, Schouten, Joost, additional, Shutter, Lori, additional, Timmons, Shelly D., additional, Ullman, Jamie S., additional, Videtta, Walter, additional, Wilberger, Jack E., additional, and Wright, David W., additional

Published
2007
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46. I. Blood Pressure and Oxygenation

Author

Bratton, Susan L., primary, Chestnut, Randall M., additional, Ghajar, Jamshid, additional, McConnell Hammond, Flora F., additional, Harris, Odette A., additional, Hartl, Roger, additional, Manley, Geoffrey T., additional, Nemecek, Andrew, additional, Newell, David W., additional, Rosenthal, Guy, additional, Schouten, Joost, additional, Shutter, Lori, additional, Timmons, Shelly D., additional, Ullman, Jamie S., additional, Videtta, Walter, additional, Wilberger, Jack E., additional, and Wright, David W., additional

Published
2007
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47. XI. Anesthetics, Analgesics, and Sedatives

Author

Bratton, Susan L., primary, Chestnut, Randall M., additional, Ghajar, Jamshid, additional, McConnell Hammond, Flora F., additional, Harris, Odette A., additional, Hartl, Roger, additional, Manley, Geoffrey T., additional, Nemecek, Andrew, additional, Newell, David W., additional, Rosenthal, Guy, additional, Schouten, Joost, additional, Shutter, Lori, additional, Timmons, Shelly D., additional, Ullman, Jamie S., additional, Videtta, Walter, additional, Wilberger, Jack E., additional, and Wright, David W., additional

Published
2007
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48. III. Prophylactic Hypothermia

Author

Bratton, Susan L., primary, Chestnut, Randall M., additional, Ghajar, Jamshid, additional, McConnell Hammond, Flora F., additional, Harris, Odette A., additional, Hartl, Roger, additional, Manley, Geoffrey T., additional, Nemecek, Andrew, additional, Newell, David W., additional, Rosenthal, Guy, additional, Schouten, Joost, additional, Shutter, Lori, additional, Timmons, Shelly D., additional, Ullman, Jamie S., additional, Videtta, Walter, additional, Wilberger, Jack E., additional, and Wright, David W., additional

Published
2007
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49. VI. Indications for Intracranial Pressure Monitoring

Author

Bratton, Susan L., primary, Chestnut, Randall M., additional, Ghajar, Jamshid, additional, McConnell Hammond, Flora F., additional, Harris, Odette A., additional, Hartl, Roger, additional, Manley, Geoffrey T., additional, Nemecek, Andrew, additional, Newell, David W., additional, Rosenthal, Guy, additional, Schouten, Joost, additional, Shutter, Lori, additional, Timmons, Shelly D., additional, Ullman, Jamie S., additional, Videtta, Walter, additional, Wilberger, Jack E., additional, and Wright, David W., additional

Published
2007
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50. V. Deep Vein Thrombosis Prophylaxis

Author

Bratton, Susan L., primary, Chestnut, Randall M., additional, Ghajar, Jamshid, additional, McConnell Hammond, Flora F., additional, Harris, Odette A., additional, Hartl, Roger, additional, Manley, Geoffrey T., additional, Nemecek, Andrew, additional, Newell, David W., additional, Rosenthal, Guy, additional, Schouten, Joost, additional, Shutter, Lori, additional, Timmons, Shelly D., additional, Ullman, Jamie S., additional, Videtta, Walter, additional, Wilberger, Jack E., additional, and Wright, David W., additional

Published
2007
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