TY - JOUR
T1 - Management of intracranial hypertension following traumatic brain injury
T2 - A best clinical practice adoption proposal for intracranial pressure monitoring and decompressive craniectomy: Joint statements by the Traumatic Brain Injury Section of the Italian Society of Neurosurgery (SINch) and the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)
AU - the Traumatic Brain Injury Section of the Italian Society of Neurosurgery (SINch)
AU - the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)
AU - Iaccarino, Corrado
AU - Lippa, Laura
AU - Munari, Marina
AU - Castioni, Carlo A.
AU - Robba, Chiara
AU - Caricato, Anselmo
AU - Pompucci, Angelo
AU - Signoretti, Stefano
AU - Zona, Gianluigi
AU - Rasulo, Frank A.
AU - Aimar, Enrico
AU - Amato, Salvatore
AU - Angileri, Filippo F.
AU - Anile, Carmelo
AU - Assietti, Roberto
AU - Baratto, Vincenzo
AU - Barbanera, Andrea
AU - Basile, Luigi
AU - Battaglia, Roberto
AU - Bellocchi, Silvio
AU - Bertuccio, Alessandro
AU - Blanco, Salvatore
AU - Bolognini, Andrea
AU - Boniferro, Benedetta
AU - Bordi, Lorenzo
AU - Bortolotti, Carlo
AU - Brandini, Vincenzo
AU - Broger, Maximilian
AU - Brollo, Marco
AU - Caffarella, Daniele D.
AU - Caggiano, Chiara
AU - Cantisani, Piero L.
AU - Capone, Crescenzo
AU - Cappelletto, Barbara
AU - Capuano, Cristiano
AU - Carangelo, Biagio
AU - Caruselli, Giuseppe
AU - Chessa, Maria A.
AU - Chiara, Massimo
AU - Chibbaro, Salvatore
AU - Cioffi, Valentina
AU - Ciprianocecchi, Paolo
AU - Colistra, Davide
AU - Conti, Carlo
AU - Contratti, Filiberto
AU - Costella, Giovanni B.
AU - Cuoci, Andrea
AU - D'Avella, Domenico
AU - D'Ercole, Manuela
AU - Toto, Roberta
N1 - Publisher Copyright:
© 2021 THEAUTHORS
PY - 2021/6
Y1 - 2021/6
N2 - No robust evidence is provided by literature regarding the management of intracranial hypertension following severe traumatic brain injury (TBI). This is mostly due to the lack of prospective randomized controlled trials (RCTs), the presence of studies containing extreme heterogeneously collected populations and controversial considerations about chosen outcome. A scientific society should provide guidelines for care management and scientific support for those areas for which evidence-based medicine has not been identified. However, RCTs in severe TBI have failed to establish intervention effectiveness, arising the need to make greater use of tools such as Consensus Conferences between experts, which have the advantage of providing recommendations based on experience, on the analysis of updated literature data and on the direct comparison of different logistic realities. The Italian scientific societies should provide guidelines following the national laws ruling the best medical practice. However, many limitations do not allow the collection of data supporting high levels of evidence for intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in patients with severe TBI. This intersociety document proposes best practice guidelines for this subsetting of patients to be adopted on a national Italian level, along with joint statements from “TBI Section” of the Italian Society of Neurosurgery (SINch) endorsed by the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Presented here is a recap of recommendations on management of ICP and DC supported a high level of available evidence and rate of agreement expressed by the assemblies during the more recent consensus conferences, where members of both groups have had a role of active participants and supporters. The listed recommendations have been sent to a panel of experts consisting of the 107 members of the “TBISection” of the SINch and the 111 members of the Neuroanesthesia and Neurocritical Care Study Group of the SIAARTI. The aim of the survey was to test a preliminary evaluation of the grade of predictable future adherence of the recommendations following this intersociety proposal. The following recommendations are suggested as representing best clinical practice, nevertheless, adoption of local multidisciplinary protocols regarding thresholds of ICP values, drug therapies, hemostasis management and perioperative care of decompressed patients is strongly recommended to improve treatment efficiency, to increase the quality of data collection and to provide more powerful evidence with future studies. Thus, for this future perspective a rapid overview of the role of the multimodal neuromonitoring in the optimal severe TB Imanagement is also provided in this document. It is reasonable to assume that the recommendations reported in this paper will in future be updated by new observations arising from future trials. They are not binding, and this document should be offered as a guidance for clinical practice through an intersociety agreement, taking in consideration the low level of evidence.
AB - No robust evidence is provided by literature regarding the management of intracranial hypertension following severe traumatic brain injury (TBI). This is mostly due to the lack of prospective randomized controlled trials (RCTs), the presence of studies containing extreme heterogeneously collected populations and controversial considerations about chosen outcome. A scientific society should provide guidelines for care management and scientific support for those areas for which evidence-based medicine has not been identified. However, RCTs in severe TBI have failed to establish intervention effectiveness, arising the need to make greater use of tools such as Consensus Conferences between experts, which have the advantage of providing recommendations based on experience, on the analysis of updated literature data and on the direct comparison of different logistic realities. The Italian scientific societies should provide guidelines following the national laws ruling the best medical practice. However, many limitations do not allow the collection of data supporting high levels of evidence for intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in patients with severe TBI. This intersociety document proposes best practice guidelines for this subsetting of patients to be adopted on a national Italian level, along with joint statements from “TBI Section” of the Italian Society of Neurosurgery (SINch) endorsed by the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Presented here is a recap of recommendations on management of ICP and DC supported a high level of available evidence and rate of agreement expressed by the assemblies during the more recent consensus conferences, where members of both groups have had a role of active participants and supporters. The listed recommendations have been sent to a panel of experts consisting of the 107 members of the “TBISection” of the SINch and the 111 members of the Neuroanesthesia and Neurocritical Care Study Group of the SIAARTI. The aim of the survey was to test a preliminary evaluation of the grade of predictable future adherence of the recommendations following this intersociety proposal. The following recommendations are suggested as representing best clinical practice, nevertheless, adoption of local multidisciplinary protocols regarding thresholds of ICP values, drug therapies, hemostasis management and perioperative care of decompressed patients is strongly recommended to improve treatment efficiency, to increase the quality of data collection and to provide more powerful evidence with future studies. Thus, for this future perspective a rapid overview of the role of the multimodal neuromonitoring in the optimal severe TB Imanagement is also provided in this document. It is reasonable to assume that the recommendations reported in this paper will in future be updated by new observations arising from future trials. They are not binding, and this document should be offered as a guidance for clinical practice through an intersociety agreement, taking in consideration the low level of evidence.
KW - Consensus development conference
KW - Decompressive craniectomy
KW - Guideline
KW - Traumatic brain injuries
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U2 - 10.23736/S0390-5616.21.05383-2
DO - 10.23736/S0390-5616.21.05383-2
M3 - Review article
C2 - 34184860
AN - SCOPUS:85109613545
SN - 0390-5616
VL - 65
SP - 219
EP - 238
JO - Journal of Neurosurgical Sciences
JF - Journal of Neurosurgical Sciences
IS - 3
ER -