Greige Tatiana, Tao Brian S, Dangayach Neha S, Gilmore Emily J, O'Hana Nobleza Christa, Hinson H E, Chou Sherry H, Jha Ruchira M, Wahlster Sarah, Gebrewold Meron A, Lele Abhijit V, Ong Charlene J
Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 85 E Concord St., Suite 1116, Boston, MA, 02118, USA.
Chobanian and Avedisian School of Medicine, Boston University School of Medicine, Boston, MA, USA.
Neurocrit Care. 2025 Feb;42(1):207-221. doi: 10.1007/s12028-024-02077-0. Epub 2024 Jul 31.
Cerebral edema is a common, potentially life-threatening complication in critically ill patients with acute brain injury. However, uncertainty remains regarding best monitoring and treatment strategies, which may result in wide practice variations.
A 20-question digital survey on monitoring and management practices was disseminated between July 2022 and May 2023 to clinicians who manage cerebral edema. The survey was promoted through email, social media, medical conferences, and the Neurocritical Care Society Web site. We used the χ test, Fisher's exact test, analysis of variance, and logistic regression to report factors associated with practice variation, diagnostic monitoring methods, and therapeutic triggers based on practitioner and institutional characteristics.
Of 321 participants from 160 institutions in 30 countries, 65% were from university-affiliated centers, 74% were attending physicians, 38% were woman, 38% had neurology training, and 55% were US-based. Eighty-four percent observed practice variations at their institutions, with "provider preference" being cited most (87%). Factors linked to variation included gender, experience, university affiliation, and practicing outside the United States. University affiliates tended to use more tests (median 3.87 vs. 3.43, p = 0.01) to monitor cerebral edema. Regarding management practices, 20% of respondents' preferred timing for decompressive hemicraniectomy was after 48 h, and 37% stated that radiographic findings only would be sufficient to trigger surgery. Fifty percent of respondents reported initiating osmotic therapy based on radiographic indications or prophylactically. There were no significant associations between management strategies and respondent or center characteristics. Twenty-seven percent of respondents indicated that they acquired neuroimaging at intervals of 24 h or less. Within this group, attending physicians were more likely to follow this practice (65.5% vs. 34.5%, p = 0.04).
Cerebral edema monitoring and management strategies vary. Features associated with practice variations include both practitioner and institutional characteristics. We provide a foundation for understanding practice patterns that is crucial for informing educational initiatives, standardizing guidelines, and conducting future trials.
脑水肿是急性脑损伤重症患者常见的、可能危及生命的并发症。然而，关于最佳监测和治疗策略仍存在不确定性，这可能导致广泛的实践差异。
2022年7月至2023年5月期间，向管理脑水肿的临床医生发放了一份关于监测和管理实践的20道题数字调查问卷。该调查通过电子邮件、社交媒体、医学会议和神经重症监护协会网站进行推广。我们使用χ检验、费舍尔精确检验、方差分析和逻辑回归来报告基于从业者和机构特征的与实践差异、诊断监测方法和治疗触发因素相关的因素。
来自30个国家160个机构的321名参与者中，65%来自大学附属医院，74%为主治医师，38%为女性，38%接受过神经学培训，55%来自美国。84%的人观察到其所在机构存在实践差异，其中“提供者偏好”被提及最多（87%）。与差异相关的因素包括性别、经验、大学附属关系以及在美国境外执业。大学附属医院倾向于使用更多检查（中位数3.87对3.43，p = 0.01）来监测脑水肿。关于管理实践，20%的受访者倾向于在48小时后进行减压性颅骨切除术，37%的人表示仅影像学检查结果就足以触发手术。50%的受访者报告根据影像学指征或预防性地开始渗透性治疗。管理策略与受访者或中心特征之间无显著关联。27%的受访者表示他们每隔24小时或更短时间进行一次神经影像学检查。在这一组中，主治医师更有可能遵循这种做法（65.5%对34.5%，p = 0.04）。
脑水肿监测和管理策略各不相同。与实践差异相关的特征包括从业者和机构特征。我们为理解实践模式提供了一个基础，这对于指导教育举措、规范指南和开展未来试验至关重要。
