Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands.
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Intensive Care Med. 2023 Dec;38(12):1143-1150. doi: 10.1177/08850666231186563. Epub 2023 Jul 7.
Analgo-sedation plays an important role during intensive care management of traumatic brain injury (TBI) patients, however, limited evidence is available to guide practice. We sought to quantify practice-pattern variation in neurotrauma sedation management, surveying an international sample of providers. An electronic survey consisting of 56 questions was distributed internationally to neurocritical care providers utilizing the Research Electronic Data Capture platform. Descriptive statistics were used to quantitatively describe and summarize the responses. Ninety-five providers from 37 countries responded. 56.8% were attending physicians with primary medical training most commonly in intensive care medicine (68.4%) and anesthesiology (26.3%). Institutional sedation guidelines for TBI patients were available in 43.2%. Most common sedative agents for induction and maintenance, respectively, were propofol (87.5% and 88.4%), opioids (60.2% and 70.5%), and benzodiazepines (53.4% and 68.4%). Induction and maintenance sedatives, respectively, are mostly chosen according to provider preference (68.2% and 58.9%) rather than institutional guidelines (26.1% and 35.8%). Sedation duration for patients with intracranial hypertension ranged from 24 h to 14 days. Neurological wake-up testing (NWT) was routinely performed in 70.5%. The most common NWT frequency was every 24 h (47.8%), although 20.8% performed NWT at least every 2 h. Richmond Agitation and Sedation Scale targets varied from deep sedation (34.7%) to alert and calm (17.9%). Among critically ill TBI patients, sedation management follows provider preference rather than institutional sedation guidelines. Wide practice-pattern variation exists for the type, duration, and target of sedative management and NWT performance. Future comparative effectiveness research investigating these differences may help optimize sedation strategies to promote recovery.
在创伤性脑损伤（TBI）患者的重症监护管理中，镇痛镇静起着重要作用，然而，目前可用于指导实践的证据有限。我们旨在通过调查国际范围内的提供者来量化神经创伤镇静管理中的实践模式差异。一项包含 56 个问题的电子调查利用 Research Electronic Data Capture 平台在国际范围内分发给神经危重病学提供者。使用描述性统计数据对结果进行定量描述和总结。来自 37 个国家的 95 名提供者做出了回应。56.8%是主治医生，主要接受重症监护医学（68.4%）和麻醉学（26.3%）的培训。43.2%的机构为 TBI 患者提供镇静指南。诱导和维持分别最常用的镇静剂分别是丙泊酚（87.5%和 88.4%）、阿片类药物（60.2%和 70.5%）和苯二氮䓬类药物（53.4%和 68.4%）。诱导和维持镇静剂的选择分别主要根据提供者的偏好（68.2%和 58.9%）而不是机构指南（26.1%和 35.8%）。颅内压升高患者的镇静持续时间从 24 小时到 14 天不等。常规进行神经唤醒测试（NWT）的占 70.5%。最常见的 NWT 频率是每 24 小时一次（47.8%），尽管 20.8%的患者至少每 2 小时进行一次 NWT。Richmond 躁动镇静量表的目标从深度镇静（34.7%）到警觉和镇静（17.9%）不等。在重症 TBI 患者中，镇静管理遵循提供者的偏好，而不是机构镇静指南。镇静管理的类型、持续时间和目标以及 NWT 表现存在广泛的实践模式差异。未来针对这些差异的比较效果研究可能有助于优化镇静策略，促进康复。
