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

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

doi:10.1007/s00134-019-05805-9

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

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

Research output: Contribution to journal › Article › Other › peer-review

182 Citations (Scopus)

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.

Original language	English
Pages (from-to)	1783-1794
Number of pages	12
Journal	Intensive Care Medicine
Volume	45
Issue number	12
DOIs	https://doi.org/10.1007/s00134-019-05805-9
Publication status	Published - Dec 2019

Keywords

Algorithm
Brain injury
Consensus
Head trauma
Intracranial pressure
Protocol
Seattle
SIBICC
Tiers

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318493892-oaFinal published version, 4.68 MBLicence: CC BY-NC

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Hawryluk, G. W. J., Aguilera, S., Buki, A., Bulger, E., Citerio, G., Cooper, D. J., Arrastia, R. D., Diringer, M., Figaji, A., Gao, G., Geocadin, R., Ghajar, J., Harris, O., Hoffer, A., Hutchinson, P., Joseph, M., Kitagawa, R., Manley, G., Mayer, S., ... Chesnut, R. M. (2019). A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Medicine, 45(12), 1783-1794. https://doi.org/10.1007/s00134-019-05805-9

@article{e7da3be14c714db18af0596b3916ef0f,

title = "A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)",

abstract = "Background: Management algorithms for adult severe traumatic brain injury (sTBI) were omitted in later editions of the Brain Trauma Foundation{\textquoteright}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{\textquoteright} 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.",

keywords = "Algorithm, Brain injury, Consensus, Head trauma, Intracranial pressure, Protocol, Seattle, SIBICC, Tiers",

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

year = "2019",

month = dec,

doi = "10.1007/s00134-019-05805-9",

language = "English",

volume = "45",

pages = "1783--1794",

journal = "Intensive Care Medicine",

issn = "0342-4642",

publisher = "Springer-Verlag London Ltd.",

number = "12",

}

Hawryluk, GWJ, Aguilera, S, Buki, A, Bulger, E, Citerio, G, Cooper, DJ, Arrastia, RD, 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, DK, Meyfroidt, G, Michael, DB, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, JV, Rubiano, AM, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, FS, Timmons, S, Tsai, E, Ullman, JS, Vespa, P, Videtta, W, Wright, DW, Zammit, C & Chesnut, RM 2019, 'A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)', Intensive Care Medicine, vol. 45, no. 12, pp. 1783-1794. https://doi.org/10.1007/s00134-019-05805-9

A management algorithm for patients with intracranial pressure monitoring : the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). / Hawryluk, Gregory W.J.; Aguilera, Sergio; Buki, Andras et al.

In: Intensive Care Medicine, Vol. 45, No. 12, 12.2019, p. 1783-1794.

Research output: Contribution to journal › Article › Other › peer-review

TY - JOUR

T1 - A management algorithm for patients with intracranial pressure monitoring

T2 - the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)

AU - Hawryluk, Gregory W.J.

AU - Aguilera, Sergio

AU - Buki, Andras

AU - Bulger, Eileen

AU - Citerio, Giuseppe

AU - Cooper, D. Jamie

AU - Arrastia, Ramon Diaz

AU - Diringer, Michael

AU - Figaji, Anthony

AU - Gao, Guoyi

AU - Geocadin, Romergryko

AU - Ghajar, Jamshid

AU - Harris, Odette

AU - Hoffer, Alan

AU - Hutchinson, Peter

AU - Joseph, Mathew

AU - Kitagawa, Ryan

AU - Manley, Geoffrey

AU - Mayer, Stephan

AU - Menon, David K.

AU - Meyfroidt, Geert

AU - Michael, Daniel B.

AU - Oddo, Mauro

AU - Okonkwo, David

AU - Patel, Mayur

AU - Robertson, Claudia

AU - Rosenfeld, Jeffrey V.

AU - Rubiano, Andres M.

AU - Sahuquillo, Juan

AU - Servadei, Franco

AU - Shutter, Lori

AU - Stein, Deborah

AU - Stocchetti, Nino

AU - Taccone, Fabio Silvio

AU - Timmons, Shelly

AU - Tsai, Eve

AU - Ullman, Jamie S.

AU - Vespa, Paul

AU - Videtta, Walter

AU - Wright, David W.

AU - Zammit, Christopher

AU - Chesnut, Randall M.

PY - 2019/12

Y1 - 2019/12

N2 - 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.

AB - 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.

KW - Algorithm

KW - Brain injury

KW - Consensus

KW - Head trauma

KW - Intracranial pressure

KW - Protocol

KW - Seattle

KW - SIBICC

KW - Tiers

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U2 - 10.1007/s00134-019-05805-9

DO - 10.1007/s00134-019-05805-9

M3 - Article

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AN - SCOPUS:85074474298

VL - 45

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EP - 1794

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 12

ER -

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

Abstract

Keywords

Access to Document

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

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