Barrit Sami, Al Barajraji Mejdeddine, El Hadwe Salim, Niset Alexandre, Foreman Brandon, Park Soojin, Lazaridis Christos, Shutter Lori, Appavu Brian, Kirschen Matthew P, Montellano Felipe A, Rass Verena, Torcida Nathan, Pinggera Daniel, Gilmore Emily, Ben-Hamouda Nawfel, Massager Nicolas, Bernard Francis, Robba Chiara, Taccone Fabio Silvio
Department of Neurosurgery, CHU Tivoli, Université Libre de Bruxelles, Brussels, Belgium.
Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
Crit Care. 2024 Dec 20;28(1):427. doi: 10.1186/s13054-024-05211-8.
Intracranial multimodal monitoring (iMMM) is increasingly used in neurocritical care, but a lack of standardization hinders its evidence-based development. Here, we devised core outcome sets (COS) and reporting guidelines to harmonize iMMM practices and research.
An open, decentralized, three-round Delphi consensus study involved experts between December 2023 and June 2024. Items-spanning three domains: (i) patient characteristics, (ii) practices, and (iii) outcomes-with ≥ 75% agreement were classified as strong agreement, while those with 50-75% were reconsidered in subsequent rounds, requiring ≥ 66% for moderate agreement.
An international, multidisciplinary panel comprised 58 neurocritical physicians and researchers with low attrition (12%). They were predominantly from Western regions (96%), actively involved in iMMM (82%), at least weekly (72.4%), with more than 10 years of specific experience (57%). Of the 127 items assessed for inclusion in COS and reporting guidelines, 45 (35.4%) reached strong and 8 (6.3%) moderate agreement. Main strong agreement items were: (i) demographics: age (98%) and sex/gender (90%); comorbidities: coagulation/platelet disorders (95%); initial scoring: Glasgow Coma Scale (97%) and pathology-specific scores (90%); active treatments: antithrombotics (95%) (ii) clinical practice: iMMM implantation indications (98%) and iMMM-guided interventions (91%); surgical practice: targeting strategies (97%) and concomitant external ventricular drainage (97%); technical details: recording modalities (98%); (iii) monitoring parameters: duration (97%) and triggered interventions (95%); standardized outcome reporting (93%); surgical complications (e.g., postoperative intracranial hemorrhages, CNS infections, and probe misplacement, all > 90%) and adverse events (accidental dislodgement, probe breakage, and technical malfunctions, all > 90%).
This consensus establishes foundational COS and reporting guidelines for iMMM in neurocritical care. These harmonization tools can enhance research quality, comparability, and reproducibility, facilitating evidence-based practices for this emerging technology. However, challenges remain in developing purpose-specific guidelines and adapting them to diverse clinical and research settings.
颅内多模态监测（iMMM）在神经重症监护中应用日益广泛，但缺乏标准化阻碍了其循证发展。在此，我们制定了核心结局集（COS）和报告指南，以统一iMMM的实践和研究。
2023年12月至2024年6月，一项开放、分散的三轮德尔菲共识研究纳入了专家。涉及三个领域的项目：（i）患者特征，（ii）实践，以及（iii）结局，达成≥75%共识的项目被归类为强共识，达成50 - 75%共识的项目在后续轮次中重新审议，中等共识要求≥66%。
一个国际多学科小组由58名神经重症医生和研究人员组成，流失率较低（12%）。他们主要来自西部地区（96%），积极参与iMMM（82%），至少每周参与（72.4%），具有超过10年的特定经验（57%）。在评估纳入COS和报告指南的127个项目中，45个（35.4%）达成强共识，8个（6.3%）达成中等共识。主要的强共识项目包括：（i）人口统计学：年龄（98%）和性别（90%）；合并症：凝血/血小板疾病（95%）；初始评分：格拉斯哥昏迷量表（97%）和病理特异性评分（90%）；积极治疗：抗血栓药物（95%）（ii）临床实践：iMMM植入指征（98%）和iMMM指导的干预措施（91%）；外科实践：靶向策略（97%）和同期外部脑室引流（97%）；技术细节：记录方式（98%）；（iii）监测参数：持续时间（97%）和触发的干预措施（95%）；标准化结局报告（93%）；手术并发症（如术后颅内出血、中枢神经系统感染和探头误置，均>90%）和不良事件（意外移位、探头断裂和技术故障，均>90%）。
本共识为神经重症监护中的iMMM建立了基础COS和报告指南。这些统一工具可提高研究质量、可比性和可重复性，促进这一新兴技术的循证实践。然而，在制定针对特定目的的指南并使其适应不同临床和研究环境方面仍存在挑战。
