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Development of a Severe Traumatic Brain Injury Consensus-Based Treatment Protocol Conference in Latin America.
Hendrickson, Peter; Pridgeon, James; Temkin, Nancy R; Videtta, Walter; Petroni, Gustavo; Lujan, Silvia; Guadagnoli, Nahuel; Urbina, Zulma; Pahnke, Perla Blanca; Godoy, Daniel; Pinero, Gustavo; Lora, Freddy Sandi; Aguilera, Sergio; Rubiano, Andres M; Morejon, Caridad Soler; Jibaja, Manuel; Lopez, Hubiel; Romero, Ricardo; Dikmen, Sureyya; Chaddock, Kelley; Chesnut, Randall M.
Afiliación
  • Hendrickson P; Harborview Medical Center, University of Washington, Seattle, Washington, USA.
  • Pridgeon J; Harborview Medical Center, University of Washington, Seattle, Washington, USA.
  • Temkin NR; Harborview Medical Center, University of Washington, Seattle, Washington, USA.
  • Videtta W; Hospital Nacional Professor Alejandro Posadas, Buenos Aires, Argentina.
  • Petroni G; Hospital Emergencia, Dr. Clemente Alvarez, Rosario, Argentina.
  • Lujan S; Hospital Emergencia, Dr. Clemente Alvarez, Rosario, Argentina.
  • Guadagnoli N; Hospital Emergencia, Hospital Privado de Rosario, Rosario, Argentina.
  • Urbina Z; Hospital Erasmo Meoz ICU #1, Cucuta, Colombia.
  • Pahnke PB; Hospital Municipal de Urgencias, Cordoba, Argentina.
  • Godoy D; Sanatorio Pasteur, Catamarca, Argentina.
  • Pinero G; Leonidas, Lucero Hospital, Bahia Blanca, Argentina.
  • Lora FS; Hospital Obrero No 1 de La Paz, La Paz, Bolivia.
  • Aguilera S; Hospital Regional, Inquique, Chile.
  • Rubiano AM; Meditech Foundation, El Bosque University, Neiva, Colombia.
  • Morejon CS; Ameijeiras Hospital, La Habana, Cuba.
  • Jibaja M; Hospital Eugenio Espejo, Quito, Ecuador.
  • Lopez H; Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic.
  • Romero R; Fundación Clinica Campbell, Barranquilla, Colombia.
  • Dikmen S; Harborview Medical Center, University of Washington, Seattle, Washington, USA.
  • Chaddock K; Harborview Medical Center, University of Washington, Seattle, Washington, USA.
  • Chesnut RM; Harborview Medical Center, University of Washington, Seattle, Washington, USA. Electronic address: chesnutr@uw.edu.
World Neurosurg ; 110: e952-e957, 2018 Feb.
Article en En | MEDLINE | ID: mdl-29203307
BACKGROUND: Severe traumatic brain injury (sTBI) is a significant global health problem disproportionately affecting low- and middle-income countries (LMICs). Management of intracranial hypertension in sTBI is crucial to survival and optimal recovery. Practitioners in high-income countries routinely use intracranial pressure (ICP) monitors although their usefulness has been questioned. ICP monitors are usually unavailable in LMICs. No consensus-based/tested protocols or literature exists for sTBI treatment without ICP monitoring. METHODS: Investigators developed serial SurveyMonkey surveys for Latin American neurointensivists and neurosurgeons to determine current practice. These clinicians had extensive routine ongoing experience in sTBI without ICP monitoring. Surveys were administered and analyzed before/during/after a 2015 Buenos Aires consensus conference. Investigators identified areas of convergence blinded from colleagues' responses. A 47-clinician task force, representing 15 countries, who routinely manage patients with sTBI without monitors developed consensus-based treatment guidelines during a 3-day facilitated conference. RESULTS: Elements were added to the protocol at an 80% agreement threshold. Follow-on surveys resolved remaining elements to 97% agreement. The protocol addresses both tapering (on improvement) and neuroworsening. Staged treatment options were identified, plus unique clinical practice issues. This process introduced a research method to a large multidisciplinary group of LMIC clinicians. This report describes the process used to develop an LMIC-specific protocol that is transferable to other diseases/injuries. The protocol is being tested in 5 LMICs. CONCLUSIONS: We derived consensus-based guidelines for sTBI treatment without ICP monitoring, and introduced a research method to a large multidisciplinary group of LMIC clinicians naive to such methods.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Protocolos Clínicos / Hipertensión Intracraneal / Consenso / Lesiones Traumáticas del Encéfalo Tipo de estudio: Etiology_studies / Guideline / Prognostic_studies / Qualitative_research Límite: Humans Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2018 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Protocolos Clínicos / Hipertensión Intracraneal / Consenso / Lesiones Traumáticas del Encéfalo Tipo de estudio: Etiology_studies / Guideline / Prognostic_studies / Qualitative_research Límite: Humans Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2018 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos