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001-es BibID:	BIBFORM070421
Első szerző:	Cnossen, Maryse C.
Cím:	Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury : a survey in 66 neurotrauma centers participating in the CENTER-TBI study / Maryse C. Cnossen, Jilske A. Huijben, Mathieu van der Jagt, Victor Volovici, Thomas van Essen, Suzanne Polinder, David Nelson, Ari Ercole, Nino Stocchetti, Giuseppe Citerio, Wilco C. Peul, Andrew I. R. Maas, David Menon, Ewout W. Steyerberg, Hester F. Lingsma, CENTER-TBI Investigators and Participants
Dátum:	2017
ISSN:	1364-8535 1466-609X
Megjegyzések:	Background: No definitive evidence exists on how intracranial hypertension should be treated in patients withtraumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefitsand risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim ofthis study was to examine variation in monitoring and treatment policies for intracranial hypertension in patientswith TBI.Methods: A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expertopinion, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participatingin the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study.Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals(n = 60, 91%) and designated level I trauma centers (n = 44, 67%). The Brain Trauma Foundation guidelines wereused in 49 (74%) centers. Approximately 90% of the participants (n = 58) indicated placing an ICP monitor inpatients with severe TBI and computed tomographic abnormalities. There was no consensus on other indicationsor on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevatedICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring andtreatment (n = 32, 48%), whereas the others were considered more conservative (n = 34, 52%).Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with TBI andintracranial hypertension. The results of this survey indicate a lack of consensus between European neurotraumacenters and provide an opportunity and necessity for comparative effectiveness research.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban Traumatic brain injury Intracranial hypertension ICP ICU Comparative effectiveness research Survey
Megjelenés:	Critical Care. - 21/2017 (2017), p. 233-245. -
További szerzők:	Huijben, Jilske A. van der Jagt, Mathieu Volovici, Victor van Essen, Thomas Polinder, Suzanne Nelson, David Ercole, Ari Stocchetti, Nino Citerio, Giuseppe Peul, Wilco C. Maas, Andrew I. R. Menon, David Krishna Steyerberg, Ewout W. Lingsma, Hester Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
Pályázati támogatás:	CENTER-TBI Egyéb
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001-es BibID:	BIBFORM107421
035-os BibID:	(scopus)85117210103 (wos)000681565200001
Első szerző:	van Veen, Ernest
Cím:	Occurrence and timing of withdrawal of life-sustaining measures in traumatic brain injury patients : a CENTER-TBI study / van Veen Ernest, van der Jagt Mathieu, Citerio Giuseppe, Stocchetti Nino, Gommers Diederik, Burdorf Alex, Menon David K., Maas Andrew I. R., Kompanje Erwin J. O., Lingsma Hester F., CENTER-TBI investigators and participants
Dátum:	2021
ISSN:	0342-4642
Megjegyzések:	Background: In patients with severe brain injury, withdrawal of life-sustaining measures (WLSM) is common in inten sive care units (ICU). WLSM constitutes a dilemma: instituting WLSM too early could result in death despite the pos sibility of an acceptable functional outcome, whereas delaying WLSM could unnecessarily burden patients, families, clinicians, and hospital resources. We aimed to describe the occurrence and timing of WLSM, and factors associated with timing of WLSM in European ICUs in patients with traumatic brain injury (TBI). Methods: The CENTER-TBI Study is a prospective multi-center cohort study. For the current study, patients with traumatic brain injury (TBI) admitted to the ICU and aged 16 or older were included. Occurrence and timing of WLSM were documented. For the analyses, we dichotomized timing of WLSM in early (<72 h after injury) versus later (?72 h after injury) based on recent guideline recommendations. We assessed factors associated with initiating WLSM early versus later, including geographic region, center, patient, injury, and treatment characteristics with univariable and multivariable (mixed efects) logistic regression. Results: A total of 2022 patients aged 16 or older were admitted to the ICU. ICU mortality was 13% (n=267). Of these, 229 (86%) patients died after WLSM, and were included in the analyses. The occurrence of WLSM varied between regions ranging from 0% in Eastern Europe to 96% in Northern Europe. In 51% of the patients, WLSM was early. Patients in the early WLSM group had a lower maximum therapy intensity level (TIL) score than patients in the later WLSM group (median of 5 versus 10) The strongest independent variables associated with early WLSM were one unreactive pupil (odds ratio (OR) 4.0, 95% confdence interval (CI) 1.3?12.4) or two unreactive pupils (OR 5.8, CI 2.6?13.1) compared to two reactive pupils, and an Injury Severity Score (ISS) if over 41 (OR per point above 41=1.1, CI 1.0?1.1). Timing of WLSM was not signifcantly associated with region or center. Conclusion: WLSM occurs early in half of the patients, mostly in patients with severe TBI afecting brainstem refexes who were severely injured. We found no regional or center infuences in timing of WLSM. Whether WLSM is always appropriate or may contribute to a self-fulflling prophecy requires further research and argues for reluctance to insti tute WLSM early in case of any doubt on prognosis.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban folyóiratcikk traumatic brain injury
Megjelenés:	Intensive Care Medicine. - 47 : 10 (2021), p. 1115-1129. -
További szerzők:	van der Jagt, Mathieu Citerio, Giuseppe Stocchetti, Nino Gommers, Diederik Burdorf, Alex Menon, David Krishna Maas, Andrew I. R. Kompanje, Erwin J. O. Lingsma, Hester Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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001-es BibID:	BIBFORM107423
035-os BibID:	(scopus)85110576459 (wos)000677684700016
Első szerző:	Wiegers, Eveline Janine Anna
Cím:	Fluid balance and outcome in critically ill patients with traumatic brain injury (CENTER-TBI and OzENTER-TBI) : a prospective, multicentre, comparative effectiveness study / Wiegers Eveline Janine Anna, Lingsma Hester Floor, Huijben Jilske Antonia, Cooper David James, Citerio Giuseppe, Frisvold Shirin, Helbok Raimund, Maas Andrew Ian Ramsay, Menon David Krishna, Moore Elizabeth Madeleine, Stocchetti Nino, Dippel Diederik Willem, Steyerberg Ewout Willem, van der Jagt Mathieu, CENTER-TBI Collaboration Groups, OzENTER-TBI Collaboration Groups
Dátum:	2021
ISSN:	1474-4422 1474-4465
Megjegyzések:	Background Fluid therapy?the administration of fluids to maintain adequate organ tissue perfusion and oxygenation?is essential in patients admitted to the intensive care unit (ICU) with traumatic brain injury. We aimed to quantify the variability in fluid management policies in patients with traumatic brain injury and to study the effect of this variability on patients' outcomes. Methods We did a prospective, multicentre, comparative effectiveness study of two observational cohorts: CENTER-TBI in Europe and OzENTER-TBI in Australia. Patients from 55 hospitals in 18 countries, aged 16 years or older with traumatic brain injury requiring a head CT, and admitted to the ICU were included in this analysis. We extracted data on demographics, injury, and clinical and treatment characteristics, and calculated the mean daily fluid balance (difference between fluid input and loss) and mean daily fluid input during ICU stay per patient. We analysed the association of fluid balance and input with ICU mortality and functional outcome at 6 months, measured by the Glasgow Outcome Scale Extended (GOSE). Patient-level analyses relied on adjustment for key characteristics per patient, whereas centre-level analyses used the centre as the instrumental variable. Findings 2125 patients enrolled in CENTER-TBI and OzENTER-TBI between Dec 19, 2014, and Dec 17, 2017, were eligible for inclusion in this analysis. The median age was 50 years (IQR 31 to 66) and 1566 (74%) of patients were male. The median of the mean daily fluid input ranged from 1?48 L (IQR 1?12 to 2?09) to 4?23 L (3?78 to 4?94) across centres. The median of the mean daily fluid balance ranged from ?0?85 L (IQR ?1?51 to ?0?49) to 1?13 L (0?99 to 1?37) across centres. In patient-level analyses, a mean positive daily fluid balance was associated with higher ICU mortality (odds ratio [OR] 1?10 [95% CI 1?07 to 1?12] per 0?1 L increase) and worse functional outcome (1?04 [1?02 to 1?05] per 0?1 L increase); higher mean daily fluid input was also associated with higher ICU mortality (1?05 [1?03 to 1?06] per 0?1 L increase) and worse functional outcome (1?04 [1?03 to 1?04] per 1-point decrease of the GOSE per 0?1?L increase). Centre-level analyses showed similar associations of higher fluid balance with ICU mortality (OR 1?17 [95% CI 1?05 to 1?29]) and worse functional outcome (1?07 [1?02 to 1?13]), but higher fluid input was not associated with ICU mortality (OR 0?95 [0?90 to 1?00]) or worse functional outcome (1?01 [0?98 to 1?03]).
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban folyóiratcikk traumatic brain injury
Megjelenés:	Lancet Neurology. - 20 : 8 (2021), p. 627-638. -
További szerzők:	Lingsma, Hester Huijben, Jilske A. Cooper, David James Citerio, Giuseppe Frisvold, Shirin Helbok, Raimund Maas, Andrew I. R. Menon, David Krishna Moore, Elizabeth Madeleine Stocchetti, Nino Dippel, Diederik W. Steyerberg, Ewout W. van der Jagt, Mathieu Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI collaborators OzENTER-TBI Collaboration Groups
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