Evaluation of disparities in neuro-sedation treatment for intracranial hypertension in traumatic brain injury in France: A national survey.

IMPORTANCE

Sedation is a cornerstone therapeutic option for the control of intracranial hypertension in patients with traumatic brain injury. However, the absence of specific recommendations regarding the choice of agents, their combinations, or dosing strategies contributes to the heterogeneity of sedation practices, which may be applied at varying levels of therapeutic intensity (Tier 0, 1, 2, 3).

OBJECTIVE

To describe the sedative molecules and their combinations used in the treatment of ICH in TBI in France.

METHODS

From May 1st to August 31st, 2024, a questionnaire was sent to French senior physicians working in intensive care units of level 1 trauma centers.

RESULTS

A total of 115 responses were obtained. At the initial tier of therapeutic intensity, the most frequently reported sedations were midazolam (n = 52, 45%) and propofol (n = 43, 37%). For analgesia, sufentanil was the predominant agent (96%). The most common combination at the first tier was midazolam/propofol/sufentanil (n = 78, 69%). Forty-eight respondents (42%) reported escalating to a higher level of sedation at Tier Two, most often with midazolam/propofol/ketamine/sufentanil (n = 35, 73%). Sixty-four respondents (56%) reported using barbiturate coma for intracranial hypertension refractory to Tier Two therapy.

CONCLUSION

This study describes a high level of heterogeneity in the use of sedation agents, their maximum doses, and their monitoring in the treatment of traumatic ICH among neurointensivists in France.