Protocol Management of Severe Traumatic Brain Injury in Intensive Care Units: A Systematic Review

Abstract

To examine clinical trials and observational studies that compared use of management protocols (MPs) versus usual care for adult intensive care unit (ICU) patients with acute severe traumatic brain injury (TBI) on 6-month neurologic outcome (Glasgow Outcome Scale, GOS) and mortality, major electronic databases were searched from 1950 to April 18, 2011. Abstracts from major international meetings were searched to identify gray literature. A total of 6,151 articles were identified; 488 were reviewed in full and 13 studies were included. Data on patient and MP characteristics, outcomes and methodological quality were extracted. All 13 included studies were observational. A random effects model showed that use of MPs was associated with a favorable neurologic outcome (GOS 4 or 5) at 6 months (odds ratio [OR] and 95 % confidence interval [CI] 3.84 (2.47-5.96)) but not 12 months (OR, 95 % CI 0.87 (0.56-1.36)). Use of MPs was associated with reduced mortality at hospital discharge and 6 months (OR and 95 % CI 0.72 (0.45-1.14) and 0.33 (0.13-0.82) respectively), but not 12 months (OR, 95 % CI 0.79 (0.5-1.24)). Sources of heterogeneity included variation in study design, methodological quality, MP design, MP neurophysiologic endpoints, and type of ICU. MPs for severe TBI were associated with reductions in death and improved neurologic outcome. Although no definitive conclusions about the efficacy of MPs for severe TBI can be drawn from our study, these results should encourage the conduct of randomized controlled trials to more rigorously examine the efficacy of MPs for severe TBI.

Assessment of a multi-layered diffuse correlation spectroscopy method for monitoring cerebral blood flow in adults

“…As expected, significant differences between normocapnia and hypocapnia were observed for pH and paCO 2 [p<0.001, partial-η 2 > 0.98, Power = 1]; however, significant changes in paO 2 and MAP were also observed [p<0.05, partial-η 2 > 0.69, Power > 0.85] (see Table 1), where partial-η 2 is an estimate measure of effect size. Changes were not observed for any of the other measured physiological parameters.…”

“…For the animal experiments, possible changes in the measured physiological parameters and optical properties due to altering paCO 2 or the scalp incisions were tested by a repeated measures analysis of variance (ANOVA). The same test was conducted on all measured flow parameters, which include the blood flow estimates for scalp, skull and brain measured by CTP, and for the blood flow indices measured by DCS techniques: F S and F B from the ML DCS analysis, and F HM,1 and F HM,2 from the homogeneous model.…”

“…Patients requiring intensive care due to life-threatening neurological emergencies, such as ischemic stroke, traumatic brain injury and subarachnoid hemorrhage, are at high risk of secondary brain injury [1][2][3]. Although multiple factors contribute to poor outcome, a major focus is preventing delayed cerebral ischemia.…”

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

“…[25][26][27] Several observational studies have suggested that an organized, protocol-based approach with emphasis on the prevention of ''secondary'' neurological insults may be associated with improved recovery. [28][29][30][31][32][33][34] Consistent with these developments, the care of neurocritical care patients in our region of Canada has evolved considerably over the past decade. There are few contemporary data assessing whether outcomes have changed.…”

Knowledge, Attitude and Practices in Management of Trauma Victims: A Questionnaire Based Study

“…[1,2] While many protocols are in place for management of trauma victims, ATLS protocol is a concise and comprehensive document covering principles for patient assessment and management on the whole. [3] It is a standard and internationally accepted protocol.…”