A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC).
Creators: name: Hawryluk, Gregory WJ
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, Romergryko
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: Chesnut, Randall M
Publisher: name: Springer Science and Business Media LLC
Year: 2019
Subjects: Algorithm
Brain injury
Consensus
Head trauma
Intracranial pressure
Protocol
SIBICC
Seattle
Tiers
Adult
Aged
Aged, 80 and over
Algorithms
Brain Injuries, Traumatic
Consensus Development Conferences as Topic
Female
Humans
Intracranial Hypertension
Male
Middle Aged
Monitoring, Physiologic
Practice Guidelines as Topic

description: 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.