Development of a Randomized Trial Comparing ICP-Monitor-Based Management of Severe Pediatric Traumatic Brain Injury to Management Based on Imaging and Clinical Examination Without ICP Monitoring-Research Algorithms.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Chesnut Randall, Temkin Nancy, Pridgeon James, Sulzbacher Stephen, Lujan Silvia, Videtta Walter, Moya-Barquín Luis, Chaddock Kelley, Bonow Robert H, Petroni Gustavo, Guadagnoli Nahuel, Hendrickson Peter, Ramírez Cortez Grimaldo, Carreazo Nilton Yhuri, Vargas Aymituma Alcides, Anchante Daniel, Caqui Patrick, Ramírez Alberto, Munaico Abanto Manuel, Ortiz Chicchon Manuel, Cenzano Ramos José, Castro Darce María Del Carmen, Sierra Morales Roberto, Brol Lopez Pedro, Menendez Willy, Posadas Gutierrez Sofía, Kevin Vicente, Mazariegos Andrea, de Leon Elie, Rodas Barrios Rodolfo Enrique, Rodríguez Sandra, Flores Sandra, Alvarado Ovidio, Guzman Flores Luis José, Moisa Martinez Melvin, Gonzalez Pablo
Аннотация
METHODS: A consensus conference involving the 21 intensivists and neurosurgeons from the 8 trial sites used Delphi-based methodology to formulate management algorithms for both study cohorts. We included recommendations from the latest Brain Trauma Foundation pediatric sTBI guidelines and the consensus-based adult algorithms (Seattle International Brain Injury Consensus Conference/Consensus Revised Imaging and Clinical Examination) wherever relevant. We used a consensus threshold of 80%.
RESULTS: We developed comprehensive management algorithms for monitored and nonmonitored cohort children with sTBI. We defined suspected intracranial hypertension for the nonmonitored group, set minimum number and timing of computed tomography scans, specified minimal age-adjusted mean arterial pressure and cerebral perfusion pressure targets, defined clinical neuroworsening, described minimal requisites for intensive care unit management, produced tiered management algorithms for both groups, and listed treatments not routinely used.
CONCLUSION: We will study these protocols in the Benchmark Evidence from Latin America-Treatment of Raised Intracranial Pressure-Pediatrics trial in low- and middle-income countries. Second, we present them here for consideration as prototype pediatric sTBI management algorithms in the absence of published alternatives, acknowledging their limited evidentiary status. Therefore, herein, we describe our study design only, not recommended treatment protocols.