Management of intracranial hypertension following traumatic brain injury: 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)

Anselmo Caricato, Angelo Pompucci, Cinzia Caggiano, Massimiliano Visocchi, Valerio Perotti, Carmelo Anile, Maximilian Broger, Manuela D'Ercole, Luca Denaro, Franco Servadei, Eleonora Stival, Corrado Iaccarino, Laura Lippa, Marina Munari, Carlo A. Castioni, Chiara Robba, Stefano Signoretti, Gianluigi Zona, Frank A. Rasulo, Enrico AimarSalvatore Amato, Filippo F. Angileri, Roberto Assietti, Vincenzo Baratto, Andrea Barbanera, Luigi Basile, Roberto Battaglia, Silvio Bellocchi, Alessandro Bertuccio, Salvatore Blanco, Andrea Bolognini, Benedetta Boniferro, Lorenzo Bordi, Carlo Bortolotti, Vincenzo Brandini, Marco Brollo, Daniele D. Caffarella, Chiara Caggiano, Piero L. Cantisani, Crescenzo Capone, Barbara Cappelletto, Cristiano Capuano, Biagio Carangelo, Giuseppe Caruselli, Maria A. Chessa, Massimo Chiara, Salvatore Chibbaro, Valentina Cioffi, Paolo Ciprianocecchi, Davide Colistra, Carlo Conti, Filiberto Contratti, Giovanni B. Costella, Andrea Cuoci, Domenico D'Avella, Michelangelo Deangelis, Raffaele Defalco, Gianpaolo De Luca, Pasquale De Marinis, Carlo Del Vecchio, Catia Delfinis, Federica Deodato, Nicola Desogus, Alberto Disomma, Maurizio Domenicucci, Flavia Dones, Massimiliano Fina, Leonardo Fiori, Marco Fricia, Paolo Gaetani, Roberto Gazzeri, Marisa Gentile, Antonino Germano, Reza Ghadirpour, Cosimo D. Gianfreda, Nicola Gigante, Renato Gigli, Jacopo Giorgetti, Maria Giusa, Umberto G. Gravina, Luisa Grippi, Franco Guida, Giancarlo Guizzardi, Gianpiero Iannuzzo, Massimiliano Kropp, Luigi Lattanzi, Danilo Lucantoni, Luigi Maffei, Maurizio Magliulo, Franco Marconi, Daniele Marruzzo, Niccolò Martellotta, Elisabetta Marton, Rosario Maugeri, Giuseppe Mauro, Francesco Meli, Agazio Menniti, Paolo Merciadri, Laura Milanese, Barbara Nardacci, Davide Nasi, Paolo Orvieto, Paolo Pacca, Gastone Pansini, Gabriele Panzarasa, Maurizio Passanisi, Giacomo Pavesi, Carlo Pizzoni, Flavio Pulera, Armando Rapana, Alessandro Ricci, Rossella Rispoli, Michele Rotondo, Natale Russo, Sergio Santilli, Enrico Scarano, Andreas Schwarz, Giuseppe Simonetti, Roberto Stefini, Giuseppe Talamonti, Antonio Turrisi, Vinicio M. Valente, Alessandro Villa, Marco Vindigni, Matteo Vitali, Venceslao Wierzbicki, Giampaolo Zambon, Bruno Zanotti, Francesco Zenga, Daniela Alampi, Francesco Alessandri, Fulvio Aloj, Angela Amigoni, Raffaele Aspide, Rita Bertuetti, Veronica Betti, Federico Bilotta, Valeria Bonato, Enerico Bosco, Mario Brita, Giovanni Buscema, Tullio Cafiero, Daniela Cappuccio, Mario Caradonna, Claudio G. Caria, Marilena Casartelliliviero, Pierluigi Ciritella, Salvatore Cirrincione, Giuseppe Citerio, Stefano Colelli, Francesco Coletta, Lucia Concordia, Elisabetta Congedo, Marco Covotta, Francesco Crimella, Guido Dall'Acqua, Alessandro De Cassai, Silvia Defulviis, Elena Deperi, Cristian Deana, Alfredo Delgaudio, Nazario Denittis, Salvatore Dicolandrea, Filomena Divezza, Francesco Ferri, Romeo Flocco, Costantino Fontana, Andrea Forastierimolinari, Antonio Frangiosa, Patrizia Fumagalli, Ennio Fuselli, Marco M. Garbarino, Domenico Gelormini, Cristina Geraci, Federico Geraldini, Angelo Giacomucci, Valentina Giampaoli, Donatella Giorgetti, Paolo Gritti, Simona Gualdani, Carmine Iacovazzo, Carmine Iermano, Nicola Latronico, Simona Lugari, Francesco Lusenti, Carla Maglione, Sandra Magnoni, Francesco Maiarota, Michele Malla, Mattia Marchesi, Costanza Martino, Ilaria Matteotti, Anna T. Mazzeo, Gianluigi Morello, Ida Nardiello, Francesco Paticchio, Marianna Pegoli, Mario Piazzolla, Fabio Picciafuochi, Nadir Rachedi, Danila K. Radolovich, Andreaserena Recchia, Silvana Riccardi, Stefano Romagnoli, Silvia Sala, Maria A. Scafuro, Paolo Sgarlata, Alessandra Soragni, Francesca Stefani, Gloria Stofella, Francesco Terranova, Rebecca Tinturini, Tommaso Togni, Roberta Toto, Domenica Trapani, Eleonora Tringali, Livio Tullo, Adriana Valente, Teresa Valeo, Giancarlo Varelli, Romolo Villani, Federica Zamacavicchi, Marco Zanello, Nadia Zarrillo, Nicola Zugni

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

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.
Lingua originaleEnglish
pagine (da-a)219-238
Numero di pagine20
RivistaJournal of Neurosurgical Sciences
Volume65
DOI
Stato di pubblicazionePubblicato - 2021

Keywords

  • Consensus development conference
  • Traumatic brain injuries
  • Guideline
  • Decompressive craniectomy

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