To survey the current practice of monitoring and management of severe traumatic brain injury (TBI) patients in the critical care units across the United Kingdom.
A structured telephone interview was conducted with senior medical or nursing staff of all the adult neurocritical care units. Thirty-one neurocritical care units that managed adult patients with severe TBI were identified from the Risk Adjustment in Neurocritical Care (RAIN) study and the Society of British Neurological Surgeons.
Intracranial pressure (ICP) monitoring was used in all the 31 institutions. Cerebral perfusion pressure was used in 30 of the 31 units and a Cerebral perfusion pressure target of 60 to 70 mm Hg was the most widely used target (25 of 31 units). Transcranial Doppler was used in 12 units (39%); brain tissue oxygen (PbtO2) was used in 8 (26%); cerebral microdialysis was used in 4 (13%); jugular bulb oximetry in 1 unit; and near-infrared spectrometry was not used in any unit. Continuous capnometry was used in 28 (91%) units for mechanically ventilated patients. Mannitol was the most commonly used agent for osmotherapy to treat intracranial hypertension.
We identified that there was no clear consensus and considerable variation in practice in the management of TBI patients in UK neurocritical care units. A protocol-based management has been shown to improve outcome in sepsis patients. Given the magnitude of the problem, we conclude that there is an urgent need for international consensus guidelines for management of TBI patients in critical care units.
*Department of Neurocritical Care, Queen’s Hospital, Barking Havering and Redbridge Hospitals NHS Trust, Romford, Essex
†Department of Anaesthesia, London Chest Hospital, Barts Health NHS Trust, London
‡Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK
Presented as a poster in the International symposium on intensive care and emergency medicine, (Brussels, March 2013) and the abstract was published in Critical Care. Also, this project was presented as a poster in the Society of British Neurological surgeons’ autumn meeting (Romford, September 2013) and abstract was published in British Journal of Neurosurgery.
D.S.W.: design, writing up final draft; C.T.: data collection writing up first draft, S.P.: design, data collection, and writing up final draft.
The authors have no funding or conflicts of interest to disclose.
Reprints: Dhuleep S. Wijayatilake, FRCA, FFICM, Department of Neurocritical Care, Queen’s Hospital, Barking Havering and Redbridge Hospitals NHS Trust, Romford, Essex RM7 0AG, UK (e-mail: firstname.lastname@example.org).
Received August 18, 2014
Accepted October 27, 2014