- Poster presentation
- Open Access
National survey of current protocols and management of the traumatic brain injury patients in UK ICUs
Critical Care volume 17, Article number: P326 (2013)
Following primary neurological insult, initial management of traumatic brain-injured (TBI) patients has a clearly defined pathway . However, after arrival at tertiary centers, further management is not standardized. Intracranial hypertension (ICH), systemic hypotension, hypoxia, hyperpyrexia and hypocapnia have all been shown to independently increase mortality . Despite numerous studies, there is currently no level 1 evidence to support any specific management . Our objective was to provide an overview of the current clinical management protocols in the UK.
Thirty-one ICUs managing patients with severe TBI were identified from the RAIN (Risk Adjustment In Neurocritical care) study, and a telephone survey was conducted.
A total 97% of units used a cerebral perfusion pressure protocol for the initial management, with 83% targeting pressures of 60 to 70 mmHg and 17% aimed for >70 mmHg. Ninety-one percent of units monitored CO2 routinely with 61% targeting CO2 of 4.5 to 5 kPa (Figure 1). Regarding osmotherapy, mannitol was still the preferred agent, with 48% of units using it as first line; 32% used hypertonic saline, while 20% of units used either depending on clinicians' preference. Sixteen percent questioned were currently enrolled on the Eurotherm hypothermia trial, while 16% never used hypothermia and one unit used prophylactic hypothermia routinely. The remaining 65% of units used hypothermia only to manage refractory ICH.
There is no clear consensus on the initial targets used. The surviving sepsis campaign showed that protocol-led care can reduce mortality . Perhaps it is time for a similar approach to be adopted, with specialists coming to together to review the evidence and formulate guidelines that can then be tested.
NICE: Head Injury; Triage, Assessment, Investigation and Early Management of Head Injury London: National Collaborating Centre for Acute Care; September 2007.
Wijayatilake , et al.: Updates in the management of intracranial pressure in traumatic brain injury. Curr Opin Anaesthesiol 2012, 25: 540-547. 10.1097/ACO.0b013e328357960a
Guidelines for the Management of Severe Traumatic Brain Injury 3rd edition. New York: Brain Trauma Foundation; 2007.
Barochia , et al.: Bundled care for septic shock. Crit Care Med 2010, 38: 668-678. 10.1097/CCM.0b013e3181cb0ddf
About this article
Cite this article
Lewinsohn, B., Panchatsharam, S., Wijayatilake, S. et al. National survey of current protocols and management of the traumatic brain injury patients in UK ICUs. Crit Care 17, P326 (2013). https://doi.org/10.1186/cc12264
- Traumatic Brain Injury
- Cerebral Perfusion
- Intracranial Hypertension
- Cerebral Perfusion Pressure
- Hypertonic Saline