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Use and impact of high intensity treatments in patients with traumatic brain injury across Europe: a CENTER-TBI analysis
- Source :
- Critical care, London : BioMed Central, 2021, vol. 25, iss. 1, art. no. 78, p. 1-13, Critical care, London : BioMed central, 2021, vol. 25, iss. 1, art. no. 78, p. 1-13, Critical Care, Critical Care, Vol 25, Iss 1, Pp 1-13 (2021), Critical care, Critical Care, 25(1):78. BioMed Central Ltd., Huijben, JA, Dixit, A, Stocchetti, N, Maas, AIR, Lingsma, HF, van, D J M, Nelson, D, Citerio, G, Wilson, L, Menon, DK, Ercole, A & participants, CENTER-TBI I A 2021, ' Use and impact of high intensity treatments in patients with traumatic brain injury across Europe: a CENTER-TBI analysis ', Critical care (London, England), vol. 25, no. 1, pp. 78 . https://doi.org/10.1186/s13054-020-03370-y
- Publication Year :
- 2021
-
Abstract
- Purpose To study variation in, and clinical impact of high Therapy Intensity Level (TIL) treatments for elevated intracranial pressure (ICP) in patients with traumatic brain injury (TBI) across European Intensive Care Units (ICUs). Methods We studied high TIL treatments (metabolic suppression, hypothermia (2 Results 313 of 758 patients from 52 European centres (41%) received at least one high TIL treatment with significant variation between centres (median odds ratio = 2.26). Patients often transiently received high TIL therapies without escalation from lower tier treatments. 38% of patients with high TIL treatment had favourable outcomes (GOSE ≥ 5). The use of high TIL treatment was not significantly associated with worse outcome (285 matched pairs, OR 1.4, 95% CI [1.0–2.0]). However, a sensitivity analysis excluding high TIL treatments at day 1 or use of metabolic suppression at any day did reveal a statistically significant association with worse outcome. Conclusion Substantial between-centre variation in use of high TIL treatments for TBI was found and treatment escalation to higher TIL treatments were often not preceded by more conventional lower TIL treatments. The significant association between high TIL treatments after day 1 and worse outcomes may reflect aggressive use or unmeasured confounders or inappropriate escalation strategies. Take home message Substantial variation was found in the use of highly intensive ICP-lowering treatments across European ICUs and a stepwise escalation strategy from lower to higher intensity level therapy is often lacking. Further research is necessary to study the impact of high therapy intensity treatments. Trial registration The core study was registered with ClinicalTrials.gov, number NCT02210221, registered 08/06/2014, https://clinicaltrials.gov/ct2/show/NCT02210221?id=NCT02210221&draw=1&rank=1 and with Resource Identification Portal (RRID: SCR_015582).
- Subjects :
- Male
Barbiturate
Neurologi
medicine.medical_treatment
Hypothermia
Critical Care and Intensive Care Medicine
Logistic regression
Brain herniation
0302 clinical medicine
Traumatic brain injury
Brain Injuries, Traumatic
Hyperventilation
030212 general & internal medicine
lcsh:Medical emergencies. Critical care. Intensive care. First aid
hemic and immune systems
Middle Aged
Europe
Intensive Care Units
Neurology
Decompressive craniectomy
Female
medicine.symptom
Adult
medicine.medical_specialty
Medication Therapy Management
chemical and pharmacologic phenomena
03 medical and health sciences
Intensive care
Internal medicine
medicine
Humans
In patient
Aged
business.industry
Research
barbiturates
decompressive craniectomy
hyperventilation
hypothermia
therapy intensity level
traumatic brain injury
lcsh:RC86-88.9
Therapy intensity level
medicine.disease
Logistic Models
Barbiturates
Human medicine
Intracranial Hypertension
business
030217 neurology & neurosurgery
Subjects
Details
- Language :
- English
- ISSN :
- 13648535 and 1466609X
- Database :
- OpenAIRE
- Journal :
- Critical care, London : BioMed Central, 2021, vol. 25, iss. 1, art. no. 78, p. 1-13, Critical care, London : BioMed central, 2021, vol. 25, iss. 1, art. no. 78, p. 1-13, Critical Care, Critical Care, Vol 25, Iss 1, Pp 1-13 (2021), Critical care, Critical Care, 25(1):78. BioMed Central Ltd., Huijben, JA, Dixit, A, Stocchetti, N, Maas, AIR, Lingsma, HF, van, D J M, Nelson, D, Citerio, G, Wilson, L, Menon, DK, Ercole, A & participants, CENTER-TBI I A 2021, ' Use and impact of high intensity treatments in patients with traumatic brain injury across Europe: a CENTER-TBI analysis ', Critical care (London, England), vol. 25, no. 1, pp. 78 . https://doi.org/10.1186/s13054-020-03370-y
- Accession number :
- edsair.doi.dedup.....189385e68beb2f805291c2aa809c07be
- Full Text :
- https://doi.org/10.1186/s13054-020-03370-y