A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC).
Creators: name: Chesnut, Randall
name: Aguilera, Sergio
name: Buki, Andras
name: Bulger, Eileen
name: Citerio, Giuseppe
name: Cooper, D Jamie
name: Arrastia, Ramon Diaz
name: Diringer, Michael
name: Figaji, Anthony
name: Gao, Guoyi
name: Geocadin, Romer
name: Ghajar, Jamshid
name: Harris, Odette
name: Hoffer, Alan
name: Hutchinson, Peter
name: Joseph, Mathew
name: Kitagawa, Ryan
name: Manley, Geoffrey
name: Mayer, Stephan
name: Menon, David K
name: Meyfroidt, Geert
name: Michael, Daniel B
name: Oddo, Mauro
name: Okonkwo, David
name: Patel, Mayur
name: Robertson, Claudia
name: Rosenfeld, Jeffrey V
name: Rubiano, Andres M
name: Sahuquillo, Juan
name: Servadei, Franco
name: Shutter, Lori
name: Stein, Deborah
name: Stocchetti, Nino
name: Taccone, Fabio Silvio
name: Timmons, Shelly
name: Tsai, Eve
name: Ullman, Jamie S
name: Vespa, Paul
name: Videtta, Walter
name: Wright, David W
name: Zammit, Christopher
name: Hawryluk, Gregory WJ
Publisher: name: Springer Science and Business Media LLC
Year: 2020
Subjects: Algorithm
Brain injury
Brain oxygen
Consensus
Head trauma
Intracranial pressure
PbtO2
Protocol
SIBICC
Seattle
Tiers
Adult
Algorithms
Brain
Brain Injuries, Traumatic
Humans
Intracranial Hypertension
Intracranial Pressure
Monitoring, Physiologic
Oxygen

description: 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.