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GUIDELINES FOR THE MANAGEMENT OF
SEVERE
TRAUMATIC BRAIN INJURY 4TH EDITION
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Guidelines for the Management of Severe
Traumatic Brain Injury 4th Edition
Nancy Carney, PhD Oregon Health & Science University, Portland, OR Annette M. Totten, PhD Oregon
Health & Science University, Portland, OR Cindy O'Reilly, BS Oregon Health & Science University,
Portland, OR Jamie S. Ullman, MD Hofstra North ShoreLIJ School of Medicine, Hempstead, NY
Gregory W. J. Hawryluk, MD, PhD University of Utah, Salt Lake City, UT Michael J. Bell, MD
University of Pittsburgh, Pittsburgh, PA Susan L. Bratton, MD University of Utah, Salt Lake City, UT
Randall Chesnut, MD University of Washington, Seattle, WA Odette A. Harris, MD, MPH Stanford
University, Stanford, CA Niranjan Kissoon, MD University of British Columbia, Vancouver, BC Andres
M. Rubiano, MD El Bosque University, Bogota, Colombia; MEDITECH
Foundation, Neiva, Colombia Lori Shutter, MD University
of Pittsburgh, Pittsburgh, PA Robert C. Tasker, MBBS, MD Harvard Medical School & Boston
Children’s Hospital,
Boston, MA Monica S. Vavilala, MD University of
Washington, Seattle, WA Jack Wilberger, MD Drexel University, Pittsburgh, PA David W. Wright, MD
Emory University, Atlanta, GA Jamshid Ghajar, MD, PhD Stanford University, Stanford, CA
Reviewed for evidencebased integrity and endorsed by the American Association of
Neurological Surgeons and the Congress of Neurological Surgeons.
September 2016
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TABLE OF CONTENTS
PREFACE ......................................................................................................................................
5
ACKNOWLEDGEMENTS .............................................................................................................................................
. 5 FUNDING
SOURCE ...................................................................................................................................................... 6
DISCLAIMER OF
LIABILITY ........................................................................................................................................ 6 CONFLICT OF
INTEREST DISCLOSURE ........................................................................................................................ 7
AUTHORS’ PREFACE ..................................................................................................................................................
7 INTRODUCTION......................................................................................................................... 8
BRAIN TRAUMA RESEARCH: CURRENT
CONDITIONS ................................................................................................. 8 THE BRAIN TRAUMA
FOUNDATION’S POSITION ........................................................................................................ 9 THE BRAIN
TRAUMA EVIDENCEBASED CONSORTIUM ............................................................................................ 12
METHODS .................................................................................................................................. 14
SYSTEMATIC EVIDENCE REVIEW AND
SYNTHESIS ................................................................................................... 14 DEVELOPMENT OF
RECOMMENDATIONS .................................................................................................................. 22 EVIDENCE
SYNTHESIS AND RECOMMENDATIONS, PART I: TREATMENTS ....... 25
1. DECOMPRESSIVE CRANIECTOMY ...................................................................................................................
26 2. PROPHYLACTIC
HYPOTHERMIA ...................................................................................................................... 36 3.
HYPEROSMOLAR THERAPY ............................................................................................................................ 49 4.
CEREBROSPINAL FLUID DRAINAGE ................................................................................................................ 57
5. VENTILATION THERAPIES .............................................................................................................................. 62
6. ANESTHETICS, ANALGESICS, AND SEDATIVES ...............................................................................................
67 7. STEROIDS ....................................................................................................................................................... 76
8. NUTRITION ..................................................................................................................................................... 84 9.
INFECTION PROPHYLAXIS............................................................................................................................... 99
10. DEEP VEIN THROMBOSIS PROPHYLAXIS ......................................................................................................
111 11. SEIZURE PROPHYLAXIS ................................................................................................................................
120 EVIDENCE SYNTHESIS AND RECOMMENDATIONS, PART II: MONITORING ... 130
12. INTRACRANIAL PRESSURE MONITORING ......................................................................................................
132 13. CEREBRAL PERFUSION PRESSURE
MONITORING .......................................................................................... 145 14. ADVANCED CEREBRAL
MONITORING .......................................................................................................... 151 EVIDENCE SYNTHESIS
AND RECOMMENDATIONS, PART III: THRESHOLDS .. 163
15. BLOOD PRESSURE THRESHOLDS ..................................................................................................................
164 16. INTRACRANIAL PRESSURE
THRESHOLDS ...................................................................................................... 172 17. CEREBRAL PERFUSION
PRESSURE THRESHOLDS .......................................................................................... 181 18. ADVANCED
CEREBRAL MONITORING THRESHOLDS..................................................................................... 191 FUTURE
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RESEARCH ............................................................................................................. 201
TOPIC SELECTION AND
REFINEMENT ..................................................................................................................... 201 METHODS—
INDIVIDUAL STUDIES ......................................................................................................................... 202
METHODS—SYSTEMATIC REVIEWS AND GUIDELINES
DEVELOPMENT .................................................................. 203
CONCLUSION ......................................................................................................................... 205
2
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GUIDELINES FOR THE MANAGEMENT OF
SEVERE
TRAUMATIC BRAIN INJURY 4TH EDITION
Downloaded by: Ariah |
Distribution of this document is illegal
, Stuvia.com - The Marketplace to Buy and Sell your Study Material
Guidelines for the Management of Severe
Traumatic Brain Injury 4th Edition
Nancy Carney, PhD Oregon Health & Science University, Portland, OR Annette M. Totten, PhD Oregon
Health & Science University, Portland, OR Cindy O'Reilly, BS Oregon Health & Science University,
Portland, OR Jamie S. Ullman, MD Hofstra North ShoreLIJ School of Medicine, Hempstead, NY
Gregory W. J. Hawryluk, MD, PhD University of Utah, Salt Lake City, UT Michael J. Bell, MD
University of Pittsburgh, Pittsburgh, PA Susan L. Bratton, MD University of Utah, Salt Lake City, UT
Randall Chesnut, MD University of Washington, Seattle, WA Odette A. Harris, MD, MPH Stanford
University, Stanford, CA Niranjan Kissoon, MD University of British Columbia, Vancouver, BC Andres
M. Rubiano, MD El Bosque University, Bogota, Colombia; MEDITECH
Foundation, Neiva, Colombia Lori Shutter, MD University
of Pittsburgh, Pittsburgh, PA Robert C. Tasker, MBBS, MD Harvard Medical School & Boston
Children’s Hospital,
Boston, MA Monica S. Vavilala, MD University of
Washington, Seattle, WA Jack Wilberger, MD Drexel University, Pittsburgh, PA David W. Wright, MD
Emory University, Atlanta, GA Jamshid Ghajar, MD, PhD Stanford University, Stanford, CA
Reviewed for evidencebased integrity and endorsed by the American Association of
Neurological Surgeons and the Congress of Neurological Surgeons.
September 2016
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Distribution of this document is illegal
, Stuvia.com - The Marketplace to Buy and Sell your Study Material
TABLE OF CONTENTS
PREFACE ......................................................................................................................................
5
ACKNOWLEDGEMENTS .............................................................................................................................................
. 5 FUNDING
SOURCE ...................................................................................................................................................... 6
DISCLAIMER OF
LIABILITY ........................................................................................................................................ 6 CONFLICT OF
INTEREST DISCLOSURE ........................................................................................................................ 7
AUTHORS’ PREFACE ..................................................................................................................................................
7 INTRODUCTION......................................................................................................................... 8
BRAIN TRAUMA RESEARCH: CURRENT
CONDITIONS ................................................................................................. 8 THE BRAIN TRAUMA
FOUNDATION’S POSITION ........................................................................................................ 9 THE BRAIN
TRAUMA EVIDENCEBASED CONSORTIUM ............................................................................................ 12
METHODS .................................................................................................................................. 14
SYSTEMATIC EVIDENCE REVIEW AND
SYNTHESIS ................................................................................................... 14 DEVELOPMENT OF
RECOMMENDATIONS .................................................................................................................. 22 EVIDENCE
SYNTHESIS AND RECOMMENDATIONS, PART I: TREATMENTS ....... 25
1. DECOMPRESSIVE CRANIECTOMY ...................................................................................................................
26 2. PROPHYLACTIC
HYPOTHERMIA ...................................................................................................................... 36 3.
HYPEROSMOLAR THERAPY ............................................................................................................................ 49 4.
CEREBROSPINAL FLUID DRAINAGE ................................................................................................................ 57
5. VENTILATION THERAPIES .............................................................................................................................. 62
6. ANESTHETICS, ANALGESICS, AND SEDATIVES ...............................................................................................
67 7. STEROIDS ....................................................................................................................................................... 76
8. NUTRITION ..................................................................................................................................................... 84 9.
INFECTION PROPHYLAXIS............................................................................................................................... 99
10. DEEP VEIN THROMBOSIS PROPHYLAXIS ......................................................................................................
111 11. SEIZURE PROPHYLAXIS ................................................................................................................................
120 EVIDENCE SYNTHESIS AND RECOMMENDATIONS, PART II: MONITORING ... 130
12. INTRACRANIAL PRESSURE MONITORING ......................................................................................................
132 13. CEREBRAL PERFUSION PRESSURE
MONITORING .......................................................................................... 145 14. ADVANCED CEREBRAL
MONITORING .......................................................................................................... 151 EVIDENCE SYNTHESIS
AND RECOMMENDATIONS, PART III: THRESHOLDS .. 163
15. BLOOD PRESSURE THRESHOLDS ..................................................................................................................
164 16. INTRACRANIAL PRESSURE
THRESHOLDS ...................................................................................................... 172 17. CEREBRAL PERFUSION
PRESSURE THRESHOLDS .......................................................................................... 181 18. ADVANCED
CEREBRAL MONITORING THRESHOLDS..................................................................................... 191 FUTURE
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RESEARCH ............................................................................................................. 201
TOPIC SELECTION AND
REFINEMENT ..................................................................................................................... 201 METHODS—
INDIVIDUAL STUDIES ......................................................................................................................... 202
METHODS—SYSTEMATIC REVIEWS AND GUIDELINES
DEVELOPMENT .................................................................. 203
CONCLUSION ......................................................................................................................... 205
2
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