Use and impact of high intensity treatments in patients with traumatic brain injury across Europe: a CENTER-TBI analysis
Creators: name: Huijben, Jilske A.
name: Dixit, Abhishek
name: Stocchetti, Nino
name: Maas, Andrew I. R.
name: Lingsma, Hester F.
name: Van Der Jagt, Mathieu
name: Nelson, David
name: Citerio, Giuseppe
name: Wilson, Lindsay
name: Menon, David K.
name: Ercole, Ari
name: Åkerlund, Cecilia
name: Amrein, Krisztina
name: Andelic, Nada
name: Andreassen, Lasse
name: Audibert, Gérard
name: Azouvi, Philippe
name: Azzolini, Maria Luisa
name: Bartels, Ronald
name: Beer, Ronny
name: Bellander, Bo-Michael
name: Benali, Habib
name: Berardino, Maurizio
name: Beretta, Luigi
name: Beqiri, Erta
name: Blaabjerg, Morten
name: Lund, Stine Borgen
name: Brorsson, Camilla
name: Buki, Andras
name: Cabeleira, Manuel
name: Caccioppola, Alessio
name: Calappi, Emiliana
name: Calvi, Maria Rosa
name: Cameron, Peter
name: Lozano, Guillermo Carbayo
name: León, Ana M. Castaño
name: Cavallo, Simona
name: Chevallard, Giorgio
name: Chieregato, Arturo
name: Coburn, Mark
name: Coles, Jonathan
name: Cooper, Jamie D.
name: Correia, Marta
name: Czeiter, Endre
name: Czosnyka, Marek
name: Dahyot-Fizelier, Claire
name: Dark, Paul
name: De Keyser, Véronique
name: Degos, Vincent
name: Corte, Francesco Della
name: Den Boogert, Hugo
name: Depreitere, Bart
name: Dilvesi, Dula
name: Dreier, Jens
name: Dulière, Guy-Loup
name: Ezer, Erzsébet
name: Fabricius, Martin
name: Foks, Kelly
name: Frisvold, Shirin
name: Furmanov, Alex
name: Galanaud, Damien
name: Gomez, Pedro A.
name: Grossi, Francesca
name: Gupta, Deepak
name: Haitsma, Iain
name: Helseth, Eirik
name: Hutchinson, Peter J.
name: Jankowski, Stefan
name: Johnson, Faye
name: Karan, Mladen
name: Kolias, Angelos G.
name: Kondziella, Daniel
name: Koraropoulos, Evgenios
name: Koskinen, Lars Owe
name: Kovács, Noémi
name: Kowark, Ana
name: Lagares, Alfonso
name: Laureys, Steven
name: Ledoux, Didier
name: Lejeune, Aurelie
name: Lightfoot, Roger
name: Manara, Alex
name: Martino, Costanza
name: Maréchal, Hugues
name: Mattern, Julia
name: McMahon, Catherine
name: Menovsky, Tomas
name: Misset, Benoit
name: Muraleedharan, Visakh
name: Murray, Lynnette
name: Negru, Ancuta
name: Newcombe, Virginia
name: Nyirádi, József
name: Ortolano, Fabrizio
name: Payen, Jean François
name: Perlbarg, Vincent
name: Persona, Paolo
name: Piippo-Karjalainen, Anna
name: Ples, Horia
name: Pomposo, Inigo
name: Posti, Jussi P.
name: Puybasset, Louis
name: Radoi, Andreea
name: Ragauskas, Arminas
name: Raj, Rahul
name: Rhodes, Jonathan
name: Richter, Sophie
name: Rocka, Saulius
name: Roe, Cecilie
name: Roise, Olav
name: Rosenfeld, Jeffrey V.
name: Rosenlund, Christina
name: Rosenthal, Guy
name: Rossaint, Rolf
name: Rossi, Sandra
name: Sahuquillo, Juan
name: Sandrød, Oddrun
name: Sakowitz, Oliver
name: Sanchez-Porras, Renan
name: Schirmer-Mikalsen, Kari
name: Schou, Rico Frederik
name: Smielewski, Peter
name: Sorinola, Abayomi
name: Stamatakis, Emmanuel
name: Sundström, Nina
name: Takala, Riikka
name: Tamás, Viktória
name: Tamosuitis, Tomas
name: Tenovuo, Olli
name: Thomas, Matt
name: Tibboel, Dick
name: Tolias, Christos
name: Trapani, Tony
name: Tudora, Cristina Maria
name: Vajkoczy, Peter
name: Vallance, Shirley
name: Valeinis, Egils
name: Vámos, Zoltán
name: Van Der Steen, Gregory
name: Van Wijk, Roel P. J.
name: Vargiolu, Alessia
name: Vega, Emmanuel
name: Vik, Anne
name: Vilcinis, Rimantas
name: Volovici, Victor
name: Vulekovic, Petar
name: Williams, Guy
name: Winzeck, Stefan
name: Wolf, Stefan
name: Younsi, Alexander
name: Zeiler, Frederick A.
name: Clusmann, Agate Ziverte Hans
name: Voormolen, Daphne
name: Van Dijck, Jeroen T. J. M.
name: Van Essen, Thomas A.
Publisher: name: Apollo - University of Cambridge Repository
Year: 2021
Subjects: Research
Therapy intensity level
Barbiturates
Hypothermia
Hyperventilation
Decompressive craniectomy
Traumatic brain injury

description: 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 (&lt; 35 °C), intensive hyperventilation (PaCO2 &lt; 4 kPa), and secondary decompressive craniectomy) in patients receiving ICP monitoring in the ICU stratum of the CENTER-TBI study. A random effect logistic regression model was used to determine between-centre variation in their use. A propensity score-matched model was used to study the impact on outcome (6-months Glasgow Outcome Score-extended (GOSE)), whilst adjusting for case-mix severity, signs of brain herniation on imaging, and ICP. 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&amp;draw=1&amp;rank=1 and with Resource Identification Portal (RRID: SCR_015582).