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 journalArticle

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 languageEnglish
Pages (from-to)1783-1794
JournalIntensive Care Medicine
Volume45
Issue number12
DOIs
Publication statusPublished - 2019

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Intracranial Pressure
Therapeutics
Holidays
Intracranial Hypertension
Traumatic Brain Injury
Neurologic Examination
Expert Testimony
Politics
Standard of Care
Homeostasis
Guidelines
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Keywords

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

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

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

In: Intensive Care Medicine, Vol. 45, No. 12, 2019, p. 1783-1794.

Research output: Contribution to journalArticle

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
Hawryluk, Gregory W.J. ; Aguilera, Sergio ; Buki, Andras ; Bulger, Eileen ; Citerio, Giuseppe ; Cooper, D. Jamie ; Arrastia, Ramon Diaz ; Diringer, Michael ; Figaji, Anthony ; Gao, Guoyi ; Geocadin, Romergryko ; Ghajar, Jamshid ; Harris, Odette ; Hoffer, Alan ; Hutchinson, Peter ; Joseph, Mathew ; Kitagawa, Ryan ; Manley, Geoffrey ; Mayer, Stephan ; Menon, David K. ; Meyfroidt, Geert ; Michael, Daniel B. ; Oddo, Mauro ; Okonkwo, David ; Patel, Mayur ; Robertson, Claudia ; Rosenfeld, Jeffrey V. ; Rubiano, Andres M. ; Sahuquillo, Juan ; Servadei, Franco ; Shutter, Lori ; Stein, Deborah ; Stocchetti, Nino ; Taccone, Fabio Silvio ; Timmons, Shelly ; Tsai, Eve ; Ullman, Jamie S. ; Vespa, Paul ; Videtta, Walter ; Wright, David W. ; Zammit, Christopher ; Chesnut, Randall M. / A management algorithm for patients with intracranial pressure monitoring : the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). In: Intensive Care Medicine. 2019 ; Vol. 45, No. 12. pp. 1783-1794.
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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.",
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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

Y1 - 2019

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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