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Consensus-Based Management Protocol (CREVICE Protocol) for the Treatment of Severe Traumatic Brain Injury Based on Imaging and Clinical Examination for Use When Intracranial Pressure Monitoring Is Not Employed

2020; Mary Ann Liebert, Inc.; Volume: 37; Issue: 11 Linguagem: Inglês

10.1089/neu.2017.5599

1557-9042

Randall M. Chesnut, Nancy Temkin, Walter Videtta, Gustavo Petroni, Silvia Lujan, Jim Pridgeon, Sureyya Dikmen, Kelley Chaddock, Jason Barber, Joan Machamer, Nahuel Guadagnoli, Peter Hendrickson, Sergio Aguilera, Victor Alanis, Manuel Enrique Bello Quezada, Ermitaño Bautista Coronel, Luis Bustamante, A. Cacciatori, Carlos Carricondo, Felipe Carvajal, Rafael Davila, Mario Domínguez, Jairo Antonio Figueroa Melgarejo, Maria Martha Fillipi, Daniel Agustín Godoy, Delia Cristina Gomez, Ángel Jesús Lacerda Gallardo, Juan Antonio Guerra Garcia, Gustavo la Fuente Zerain, Luis Arturo Lavadenz Cuientas, Cecilio Lequipe, Gerardo Vicente Grajales Yuca, Manuel Jibaja Vega, Michael Eduardo Kessler, Hubiel J. López Delgado, Freddy Sandi Lora, Ana Maria Mazzola, Roberto Merida Maldonado, Natascha Mezquía de Pedro, J. Ricardo Martínez Zubieta, Julio Mijangos, Jacobo Mora, Marcelo Ochoa-Parra, Perla Pahnke, Jorge Luiz da Rocha Paranhos, Gustavo Piñero, Francisco A. Rivadeneira Pilacuán, Mario Napoleon Mendez Rivera, Ricardo Romero, Andrés M. Rubiano, Alexandra Matilde Saraguro Orozco, Juan Ignacio Silesky Jiménez, Luis Silva Naranjo, Caridad de Dios Soler Morejón, Zulma Urbina,

Neonatal Respiratory Health Research

Globally, intracranial pressure (ICP) monitoring use in severe traumatic brain injury (sTBI) is inconsistent and susceptible to resource limitations and clinical philosophies. For situations without monitoring, there is no published comprehensive management algorithm specific to identifying and treating suspected intracranial hypertension (SICH) outside of the one ad hoc Imaging and Clinical Examination (ICE) protocol in the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure (BEST:TRIP) trial. As part of an ongoing National Institutes of Health (NIH)-supported project, a consensus conference involving 43 experienced Latin American Intensivists and Neurosurgeons who routinely care for sTBI patients without ICP monitoring, refined, revised, and augmented the original BEST:TRIP algorithm. Based on BEST:TRIP trial data and pre-meeting polling, 11 issues were targeted for development. We used Delphi-based methodology to codify individual statements and the final algorithm, using a group agreement threshold of 80%. The resulting CREVICE (Consensus REVised ICE) algorithm defines SICH and addresses both general management and specific treatment. SICH treatment modalities are organized into tiers to guide treatment escalation and tapering. Treatment schedules were developed to facilitate targeted management of disease severity. A decision-support model, based on the group's combined practices, is provided to guide this process. This algorithm provides the first comprehensive management algorithm for treating sTBI patients when ICP monitoring is not available. It is intended to provide a framework to guide clinical care and direct future research toward sTBI management. Because of the dearth of relevant literature, it is explicitly consensus based, and is provided solely as a resource (a "consensus-based curbside consult") to assist in treating sTBI in general intensive care units in resource-limited environments.