What are the guideline sources, guidelines and references for Traumatic brain injury ?
Guideline sources The following summarized guidelines for the management of traumatic brain injury are prepared by our editorial team based on guidelines from the French Society of Emergency Medicine (SFMU/SFAR 2022), the American Academy of Sleep Medicine (AASM 2021), and the Brain Trauma Foundation (BTF 2017). 1 2 4 Calculator Calculator Calculator Canadian Assessment of Tomog Canadian CT head rule CCHR New Orlea Guidelines 1. Respiratory support https://web.pathway.md/diseases/recDIB6Kj0rILXbBK 1/5 6/24/23, 4:08 PM Traumatic brain injury Pathway Prophylactic hyperventilation: avoid prolonged prophylactic hyperventilation with PaCO =< 25 mmHg. D Tracheostomy: perform early tracheostomy to reduce mechanical ventilation days when the overall benefit is felt to outweigh the complications associated with such a procedure. However, recognize that there is no evidence that early tracheostomy reduces mortality or the rate of nosocomial pneumonia. B 2. Medical management Treatment targets: Consider maintaining systolic BP above the following thresholds to decrease mortality and improve outcomes: 110 mmHg or above for patients 15 to 49 years of age 100 mmHg for patients 50 to 69 years of age > 110 mmHg for patients > 70 years of age. C Show 3 more Fluid resuscitation: Consider administering isotonic crystalloids as first-line fluid therapy to reduce mortality and/or to improve the neurological prognosis in patients with acute brain injury. C Avoid using colloids, particularly albumin, as fluid therapy to reduce mortality and/or to improve the neurological prognosis in patients with acute brain injury. D Mannitol: Consider administering mannitol (0.25-1 g/kg body weight) for control of raised intracranial pressure. Avoid arterial hypotension (systolic BP < 90 mmHg). C Restrict mannitol use prior to ICP monitoring to patients with signs of transtentorial herniation or progressive neurologic deterioration not attributable to extracranial causes. B Sedative agents: avoid administering barbiturates to induce burst suppression on EEG as prophylaxis against the development of intracranial hypertension. D Show 2 more Corticosteroids: do not use corticosteroids to improve outcomes or reduce intracranial pressure in patients with TBI. Do not use high-dose methylprednisolone in patients with severe TBI, as it is associated with increased mortality. D 3. Inpatient care Intracranial pressure monitoring: Perform intracranial pressure monitoring in patients with severe TBI, to reduce in-hospital and 2- week post-injury mortality. B Consider using a combination of intracranial pressure values and clinical and brain CT findings to guide management in patients with TBI. C https://web.pathway.md/diseases/recDIB6Kj0rILXbBK 2/5 6/24/23, 4:08 PM Traumatic brain injury Pathway Jugular bulb monitoring: Consider jugular bulb monitoring of arteriovenous oxygen content difference to guide management in patients with TBI, as this has been associated with reduced mortality and improved outcomes at 3 and 6 months post-injury. C Consider maintaining jugular venous saturation > 50% in patients undergoing monitoring of jugular bulb oxygen saturation. C 4. Nonpharmacologic interventions Nutritional support: Aim to attain basal caloric replacement within 5 days (and at most, within 7 days) of TBI, in order to decrease mortality. B Use transgastric jejunal feeding to reduce the incidence of ventilator-associated pneumonia. B 5. Therapeutic procedures External ventricular drainage: consider performing CSF drainage to lower intracranial pressure in patients with an initial GCS < 6 during the first 12 hours after injury. C Show 2 more Induced hypothermia: avoid using early, short-term prophylactic hypothermia as a means to to improve outcomes in patients with diffuse injury. D 6. Surgical interventions Decompresive craniectomy: Do not perform bifrontal decompressive craniectomy as a means to improve outcomes in patients with severe and diffuse TBI (without mass lesions), although recognizing that this procedure is effective to reduce intracranial pressure and may decrease ICU length of stay. D Perform a large frontotemporoparietal decompressive craniectomy (not less than 12 15 cm or 15 cm diameter) over a small frontotemporoparietal decompressive craniectomy for reduced mortality and improved neurologic outcomes in patients with severe TBI. B Landmark trials: RESCUEicp In patients with TBI and refractory elevated intracranial pressure (> 25 mmHg), surgical was superior to medical with respect to death at 6 months. Hutchinson PJ et al. N Engl J Med. 2016 Sep 22. https://web.pathway.md/diseases/recDIB6Kj0rILXbBK 3/5 6/24/23, 4:08 PM Traumatic brain injury Pathway 7. Specific circumstances Patients with post-traumatic hypersomnia: Consider offering the following medications for the treatment of adult patients with hypersomnia secondary to TBI: armodafinil modafinil. C 8. Preventative measures Thromboprophylaxis: consider using LMWH or low-dose unfractioned heparin in combination with mechanical prophylaxis. However, recognize that there is an increased risk for expansion of intracranial hemorrhage. C Seizure prophylaxis: Administer phenytoin to decrease the incidence of early post-traumatic seizures within 7 days of injury, when the overall benefit is felt to outweigh the complications associated with such treatment. However, recognize that early post-traumatic seizures have not been associated with worse outcomes. B Avoid prophylactic use of phenytoin or valproate for the prevention of late post-traumatic seizures. D Ventilator-associated pneumonia prophylaxis: avoid the use of povidone-iodine oral care to reduce ventilator-associated pneumonia, as it may be associated with an increased risk of ARDS. D Antimicrobial-impregnated catheters: consider using antimicrobial-impregnated catheters for external ventricular drain placement to prevent catheter-related infections. C References 1. Carney N, Totten AM, O'Reilly C et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017 Jan 1;80 1 6 15. Open 2. Kiran Maski, Lynn Marie Trotti, Suresh Kotagal et al. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021 Sep 1;17 9 1881 1893. Open 3. Murray MJ, DeBlock H, Erstad B et al. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient. Crit Care Med. 2016 Nov;44 11 2079 2103. Open 4. Olivier Joannes-Boyau, Philippe Le Conte, Marie-Pierre Bonnet et al. Guidelines for the choice of intravenous fluids for vascular filling in critically ill patients, 2021. Anaesth Crit Care Pain Med. 2022 Jun;41 3 101058. Open 5. Kochanek PM, Tasker RC, Carney N et al. Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines, Executive Summary. Neurosurgery. 2019 Jun 1;84 6 1169 1178. Open https://web.pathway.md/diseases/recDIB6Kj0rILXbBK 4/5 6/24/23, 4:08 PM Traumatic brain injury Pathway 6. Kochanek PM, Tasker RC, Carney N et al. Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines, Executive Summary. Neurosurgery. 2019 Jun 1;84 6 1169 1178. Open 7. Hosseinali Khalili, Rebecka Ahl, Shahram Paydar et al. Beta-Blocker Therapy in Severe Traumatic Brain Injury: A Prospective Randomized Controlled Trial. World J Surg. 2020 Jun;44 6 1844 1853. Open 8. CRASH trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury CRASH 3 a randomised, placebo- controlled trial. Lancet. 2019 Nov 9;394 10210 1713 1723. Open 9. D James Cooper, Alistair D Nichol, Michael Bailey et al. Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients With Severe Traumatic Brain Injury: The POLAR Randomized Clinical Trial. JAMA. 2018 Dec 4;320 21 2211 2220. Open 10. Peter J D Andrews, H Louise Sinclair, Aryelly Rodriguez et al. Hypothermia for Intracranial Hypertension after Traumatic Brain Injury. N Engl J Med. 2015 Dec 17;373 25 2403 12. Open 11. Alistair Nichol, Craig French, Lorraine Little et al. Erythropoietin in traumatic brain injury EPO TBI a double-blind randomised controlled trial. Lancet. 2015 Dec 19;386 10012 2499 506. Open 12. Randall M Chesnut, Nancy Temkin, Nancy Carney et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012 Dec 27;367 26 2471 81. Open 13. Michael J Palchak, James F Holmes, Cheryl W Vance et al. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med. 2003 Oct;42 4 492 506. Open 14. Andy S Jagoda, Jeffrey J Bazarian, John J Bruns Jr et al. Clinical Policy: Neuroimaging and Decisionmaking in Adult Mild Traumatic Brain Injury in the Acute Setting. Ann Emerg Med. 2008 Dec;52 6 714 48. Open 15. G Teasdale, B Jennett. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2 7872 81 4. Open 16. DAS Taskforce, Ralf Baron, Andreas Binder et al. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 DAS Guideline 2015 short version. Ger Med Sci. 2015 Nov 12;13 Doc19. Open 17. Expert Panel on Neurological Imaging, Robert Y Shih, Judah Burns et al. ACR Appropriateness Criteria Head Trauma: 2021 Update. J Am Coll Radiol. 2021 May;18 5S S13 S36. Open 18. Expert Panel on Pediatric Imaging, Maura E Ryan, Sumit Pruthi et al. ACR Appropriateness Criteria Head Trauma-Child. J Am Coll Radiol. 2020 May;17 5S S125 S137. Open https://web.pathway.md/diseases/recDIB6Kj0rILXbBK 5/5