A2 Refereed review article in a scientific journal
Targeted temperature control following traumatic brain injury: ESICM/NACCS best practice consensus recommendations
Authors: Lavinio Andrea, Coles Jonathan P., Robba Chiara, Aries Marcel, Bouzat Pierre, Chean Dara, Frisvold Shirin, Galarza Laura, Helbok Raimund, Hermanides Jeroen, van der Jagt Mathieu, Menon David K., Meyfroidt Geert, Payen Jean-Francois, Poole Daniele, Rasulo Frank, Rhodes Jonathan, Sidlow Emily, Steiner Luzius A., Taccone Fabio Silvio, Takala Riikka
Publisher: BMC
Publication year: 2024
Journal: Critical Care
Journal name in source: Critical care (London, England)
Journal acronym: Crit Care
Volume: 28
Issue: 1
ISSN: 1364-8535
eISSN: 1466-609X
DOI: https://doi.org/10.1186/s13054-024-04951-x
Web address : https://doi.org/10.1186/s13054-024-04951-x
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/404725974
AIMS AND SCOPE: The aim of this panel was to develop consensus recommendations on targeted temperature control (TTC) in patients with severe traumatic brain injury (TBI) and in patients with moderate TBI who deteriorate and require admission to the intensive care unit for intracranial pressure (ICP) management.
METHODS: A group of 18 international neuro-intensive care experts in the acute management of TBI participated in a modified Delphi process. An online anonymised survey based on a systematic literature review was completed ahead of the meeting, before the group convened to explore the level of consensus on TTC following TBI. Outputs from the meeting were combined into a further anonymous online survey round to finalise recommendations. Thresholds of ≥ 16 out of 18 panel members in agreement (≥ 88%) for strong consensus and ≥ 14 out of 18 (≥ 78%) for moderate consensus were prospectively set for all statements.
RESULTS: Strong consensus was reached on TTC being essential for high-quality TBI care. It was recommended that temperature should be monitored continuously, and that fever should be promptly identified and managed in patients perceived to be at risk of secondary brain injury. Controlled normothermia (36.0-37.5 °C) was strongly recommended as a therapeutic option to be considered in tier 1 and 2 of the Seattle International Severe Traumatic Brain Injury Consensus Conference ICP management protocol. Temperature control targets should be individualised based on the perceived risk of secondary brain injury and fever aetiology.
CONCLUSIONS: Based on a modified Delphi expert consensus process, this report aims to inform on best practices for TTC delivery for patients following TBI, and to highlight areas of need for further research to improve clinical guidelines in this setting.
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Funding information in the publication:
The Delphi Panel meeting in October 2023 was facilitated (through the provision of travel costs, meeting space and refreshments) by Becton, Dickinson and Company. The development of these consensus recommendations was conducted with strict measures to ensure independence from its sponsor. The research team independently conducted all data analyses and drafted the manuscript. The role of BD was limited to providing logistical support for the Delphi panel meeting held in London, including travel costs, meeting space, and refreshments, without any influence over the study's content or conclusions. The Delphi voting process was conducted anonymously, ensuring that panel members could freely express their professional opinions without bias or influence from the sponsoring body or among panel members. The manuscript's drafting, review, and revision processes were carried out independently of BD. The sponsor had no editorial control, ensuring that the recommendations are based on the authors’ independent, professional expertise in targeted temperature management following traumatic brain injury. This article contains the personal and professional opinions of the individual authors and does not necessarily reflect the views and opinions of Becton, Dickinson and Company (“BD”) or any Business Unit or affiliate of BD. If drugs and/or medical devices are cited in the article, please consult package insert and instructions for use of them to know indications, contraindications, and any other more detailed safety information.
