scholarly journals WSES consensus conference guidelines: monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 hours

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Edoardo Picetti ◽  
Sandra Rossi ◽  
Fikri M. Abu-Zidan ◽  
Luca Ansaloni ◽  
Rocco Armonda ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Consensus Conference ◽  
Consensus Process ◽  
International Consensus ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Complex Patients ◽  
The World ◽  
Polytrauma Patients

AbstractThe acute phase management of patients with severe traumatic brain injury (TBI) and polytrauma represents a major challenge. Guidelines for the care of these complex patients are lacking, and worldwide variability in clinical practice has been documented in recent studies. Consequently, the World Society of Emergency Surgery (WSES) decided to organize an international consensus conference regarding the monitoring and management of severe adult TBI polytrauma patients during the first 24 hours after injury. A modified Delphi approach was adopted, with an agreement cut-off of 70%. Forty experts in this field (emergency surgeons, neurosurgeons, and intensivists) participated in the online consensus process. Sixteen recommendations were generated, with the aim of promoting rational care in this difficult setting.

scholarly journals Perioperative Management of Polytrauma Patients with Severe Traumatic Brain Injury Undergoing Emergency Extracranial Surgery: A Narrative Review

2021 ◽  
Vol 11 (1) ◽  
pp. 18
Author(s):  
Edoardo Picetti ◽  
Israel Rosenstein ◽  
Zsolt J. Balogh ◽  
Fausto Catena ◽  
Fabio S. Taccone ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Trauma Team ◽  
Narrative Review ◽  
Brain Protection ◽  
Team Members ◽  
Complex Patients ◽  
Polytrauma Patients ◽  
Challenging Situation

Managing the acute phase after a severe traumatic brain injury (TBI) with polytrauma represents a challenging situation for every trauma team member. A worldwide variability in the management of these complex patients has been reported in recent studies. Moreover, limited evidence regarding this topic is available, mainly due to the lack of well-designed studies. Anesthesiologists, as trauma team members, should be familiar with all the issues related to the management of these patients. In this narrative review, we summarize the available evidence in this setting, focusing on perioperative brain protection, cardiorespiratory optimization, and preservation of the coagulative function. An overview on simultaneous multisystem surgery (SMS) is also presented.

scholarly journals Building a neuroinfectious disease consensus curriculum

Neurology ◽  
2019 ◽  
Vol 93 (5) ◽  
pp. 208-216
Author(s):  
Arun Venkatesan ◽  
Felicia C. Chow ◽  
Allen Aksamit ◽  
Russell Bartt ◽  
Thomas P. Bleck ◽  
...  
Keyword(s):  
American Academy ◽  
Delphi Technique ◽  
Fellowship Training ◽  
Consensus Process ◽  
Diverse Range ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Modified Delphi Technique ◽  
Comprehensive Curriculum ◽  
American Academy Of Neurology

ObjectiveTo delineate a comprehensive curriculum for fellowship training in neuroinfectious diseases, we conducted a modified Delphi approach to reach consensus among 11 experts in the field.MethodsThe authors invited a diverse range of experts from the American Academy of Neurology Neuro-Infectious Diseases (AAN Neuro-ID) Section to participate in a consensus process using a modified Delphi technique.ResultsA comprehensive list of topics was generated with 101 initial items. Through 3 rounds of voting and discussion, a curriculum with 83 items reached consensus.ConclusionsThe modified Delphi technique provides an efficient and rigorous means to reach consensus on topics requiring expert opinion. The AAN Neuro-ID section provided the pool of diverse experts, the infrastructure, and the community through which to accomplish the consensus project successfully. This process could be applied to other subspecialties and sections at the AAN.

scholarly journals LO042: Sonography in Hypotension and Cardiac Arrest (SHoC) - Hypotension: derivation of an evidence-based consensus algorithm for the integration of point of care ultrasound into resuscitation of hypotensive patients

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S44-S44 ◽  
Author(s):  
P. Atkinson ◽  
J. Bowra ◽  
J. Milne ◽  
M. Lambert ◽  
B. Jarman ◽  
...  
Keyword(s):  
Point Of Care ◽  
Disease Incidence ◽  
Left Ventricular ◽  
Consensus Algorithm ◽  
Professional Organizations ◽  
Clinical Indication ◽  
Point Of Care Ultrasound ◽  
International Consensus ◽  
Modified Delphi ◽  
Delphi Approach

Introduction: Point of care ultrasound has become an established tool in the initial management of patients with undifferentiated hypotension. Current established protocols (RUSH, ACES, etc) were developed by expert user opinion, rather than objective, prospective data. We wished to use reported disease incidence to develop an informed approach to PoCUS in hypotension using a “4 F’s” approach: Fluid; Form; Function; Filling. Methods: We summarized the incidence of PoCUS findings from an international multicentre RCT, and using a modified Delphi approach incorporating this data we obtained the input of 24 international experts associated with five professional organizations led by the International Federation of Emergency Medicine. The modified Delphi tool was developed to reach an international consensus on how to integrate PoCUS for hypotensive emergency department patients. Results: Rates of abnormal PoCUS findings from 151 patients with undifferentiated hypotension included left ventricular dynamic changes (43%), IVC abnormalities (27%), pericardial effusion (16%), and pleural fluid (8%). Abdominal pathology was rare (fluid 5%, AAA 2%). After two rounds of the survey, using majority consensus, agreement was reached on a SHoC-hypotension protocol comprising: A. Core: 1. Cardiac views (Sub-xiphoid and parasternal windows for pericardial fluid, cardiac form and ventricular function); 2. Lung views for pleural fluid and B-lines for filling status; and 3. IVC views for filling status; B. Supplementary: Additional cardiac views; and C. Additional views (when indicated) including peritoneal fluid, aorta, pelvic for IUP, and proximal leg veins for DVT. Conclusion: An international consensus process based on prospectively collected disease incidence has led to a proposed SHoC-hypotension PoCUS protocol comprising a stepwise clinical-indication based approach of Core, Supplementary and Additional PoCUS views.

scholarly journals The Expanding Role of Quantitative Pupillometry in the Evaluation and Management of Traumatic Brain Injury

2021 ◽  
Vol 12 ◽  
Author(s):  
Jason H. Boulter ◽  
Margaret M. Shields ◽  
Melissa R. Meister ◽  
Gregory Murtha ◽  
Brian P. Curry ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Injuries ◽  
Ease Of Use ◽  
Brain Injured ◽  
The World ◽  
Injured Patients ◽  
Austere Environments ◽  
Active Investigation

Traumatic brain injury is a rapidly increasing source of morbidity and mortality across the world. As such, the evaluation and management of traumatic brain injuries ranging from mild to severe are under active investigation. Over the last two decades, quantitative pupillometry has been increasingly found to be useful in both the immediate evaluation and ongoing management of traumatic brain injured patients. Given these findings and the portability and ease of use of modern pupillometers, further adoption and deployment of quantitative pupillometers into the preclinical and hospital settings of both resource rich and medically austere environments.

scholarly journals Disability as a result of craniocerebral trauma in Russia: actuality and forecasts

2020 ◽  
Vol 23 (2) ◽  
pp. 33-41
Author(s):  
Ilya V. Borisov ◽  
Valeriya A. Bondar ◽  
M. M. Kanarskiy ◽  
Julia Y. Nekrasova ◽  
Dmitriy S. Yankevich ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injuries ◽  
Craniocerebral Trauma ◽  
World Health ◽  
Federal State ◽  
The World ◽  
The Russian Federation ◽  
External Causes ◽  
Health Organization

According to the World Health Organization, injuries take first place among the causes of death among the population under 40 years of age. In the Russian Federation, in 2019, death from external causes, including injuries, was in third place in all deaths. Among the causes of disability first place. Mortality from severe traumatic brain injury is over 70%. The most common cause of disability and mortality is head injuries. Annually, 1.5 million people die from traumatic brain injury (TBI) in the world, and 2.4 million are disabled. According to the Federal State Budgetary Scientific Institution National Institute of Public Health named after N.A. Semashko, the annual damage from the head injury is estimated at 500 billion rubles. This is a serious socio-economic and state problem requiring complex and multidisciplinary intervention.

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