The Brussels consensus for non-invasive ICP monitoring when invasive systems are not available in the care of TBI patients (the B-ICONIC consensus, recommendations, and management algorithm).

Journal: Intensive care medicine

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Affiliated Institutions:  IRCCS Ospedale Policlinico San Martino, Genoa, Italy. kiarobba@gmail.com. Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy. Neurosciences and Intensive Care Department, Clínica del Country, Bogotá, Colombia. Faculty of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait. Department of Anesthesiology and Intensive Care, Hospital Sultan Abdul Halim, Kedah, Malaysia. Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria. Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands. Department of Neurology, University of São Paulo, São Paulo, Brazil. Department of Surgery, University of Valencia, Valencia, Spain. Department of Neurosurgery, St. Antonio and Biagio and Cesare Arrigo Hospital, Neurosurgery Unit, Alessandria, Italy. Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, Pôle Anesthésie Réanimation, Grenoble Alpes University, Grenoble, France. Universidad Pontificia Javeriana, Cali, Colombia. Department of Intensive Care, Hospital Erasme, Universitè Libre De Bruxelles, Brussels, Belgium. Department of Neurology, University of Texas Southwestern Medical Center, Dallas, USA. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. Division of Neurosurgery, Department of Clinical Neurosciences, Brain Physics Laboratory, University of Cambridge, Cambridge, UK. Pôle Anesthésie-Réanimation, Inserm, UMR , Toulouse Neuroimaging Center, ToNIC, Université Toulouse -Paul Sabatier, CHU de Toulouse, , Toulouse, France. Departamento Medicina Critica, Unidad de Cuidados Neurointensivos, Sanatorio Pasteur, Catamarca, Argentina. Department of Neurology, Baylor College of Medicine, Houston, TX, USA. Department of Neurosurgery, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India. Hospital Eugenio Espejo and Escuela de Medicina de la Universidad San Francisco de Quito, Quito, Ecuador. Department of Neurology, Saarland University Medical Center, Homburg, Germany. Unidad de Terapia Intensiva, Hospital Civil Fray Antonio Alcalde, Universidad de Guadalajara, Coronel Calderón , El Retiro, Guadalajara, Jalisco, Mexico. Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU, Louvain, Belgium. Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore. Unidad de Cuidados Intensivos, Clinicas AUNA, Chiclayo, Peru. Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. University of Medical Sciences of Havana, Havana, Cuba. Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ, USA. Department of Anesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal. Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India. University of Southern California, Los Angeles, USA. Neurosurgery Division, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. Hospital Dr. Darío Contreras, Santo Domingo, República Dominicana. Hospital Nacional Professor Alejandro Posadas, Buenos Aires, Argentina. Neuro Intensive Care Unit, Tan Tock Seng Hospital, Singapore, Singapore. Department of Neurosurgery, University of São Paulo, São Paulo, Brazil. Global Health Research Group in Acquired Brain and Spine Injuries, Cambridge, UK.

Abstract summary 

Invasive systems are commonly used for monitoring intracranial pressure (ICP) in traumatic brain injury (TBI) and are considered the gold standard. The availability of invasive ICP monitoring is heterogeneous, and in low- and middle-income settings, these systems are not routinely employed due to high cost or limited accessibility. The aim of this consensus was to develop recommendations to guide monitoring and ICP-driven therapies in TBI using non-invasive ICP (nICP) systems.A panel of 41 experts, that regularly use nICP systems for guiding TBI care, was established. Three scoping and four systematic reviews with meta-analysis were performed summarizing the current global-literature evidence. A modified Delphi method was applied for the development of recommendations. An in-person meeting with group discussions and voting was conducted. Strong recommendations were defined for an agreement of at least 85%. Weak recommendations were defined for an agreement of 75-85%.A total of 34 recommendations were provided (32 Strong, 2 Weak) divided into three domains: general consideration for nICP use, management of ICP using nICP methods and thresholds of nICP tools for escalating/de-escalating treatment. We developed four clinical algorithms for escalating treatment and heatmaps for de-escalating treatment.Using a mixed-method approach involving literature review and an in-person consensus by experts, a set of recommendations designed to assist clinicians managing TBI patients using nICP systems plus clinical assessment, in the presence or absence of brain imaging, were built. Further clinical studies are required to validate the potential use of these recommendations in the daily clinical practice.

Authors & Co-authors:  Robba Chiara C Picetti Edoardo E Vásquez-García Sebastián S Abulhasan Yasser B YB Ain Amelia A Adeleye Amos O AO Aries Marcel M Brasil Sérgio S Badenes Rafael R Bertuccio Alessandro A Bouzat Pierre P Bustamante Luis L Calabro' Lorenzo L Njimi Hassane H Cardim Danilo D Citerio Giuseppe G Czosnyka Marek M Geeraerts Thomas T Godoy Daniel A DA Hirzallah Mohammad I MI Devi Bhagavatula Indira BI Jibaja Manuel M Lochner Piergiorgio P Mijangos Méndez Julio C JC Meyfroidt Geert G Munusamy Thangaraj T Portilla Juan Pinedo JP Prabhakar Hemanshu H Rasulo Frank F Sánchez Parra Diana M DM Sarwal Aarti A Shrestha Gentle S GS Shukla Dhaval P DP Sung Gene G Tirsit Abenezer A Vásquez Franly F Videtta Walter W Wang Yu Lin YL Paiva Wellingson S WS Taccone Fabio Silvio FS Rubiano Andres M AM

Study Outcome 

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Statistics
Citations :  Vik A, Nag T, Fredriksli OA, Skandsen T, Moen KG, Schirmer-Mikalsen K, Manley GT (2008) Relationship of “dose” of intracranial hypertension to outcome in severe traumatic brain injury. J Neurosurg 109(4):678–684. https://doi.org/10.3171/JNS/2008/109/10/0678
Authors :  41
Identifiers
Doi : 10.1007/s00134-024-07756-2
SSN : 1432-1238
Study Population
Male,Female
Mesh Terms
Other Terms
Automated pupillometry;Non-invasive intracranial pressure;Optic nerve sheath diameter;Transcranial Doppler;Traumatic brain injury
Study Design
Study Approach
Systemic Review
Country of Study
Publication Country
United States