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- Neumann, JO, et al.
(författare)
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The use of hyperventilation theraphy after traumatic brain injury in Europe : an analysis of the BrainIT database
- 2008
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 34:9, s. 1676-1682
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Tidskriftsartikel (refereegranskat)abstract
- Objective To assess the use of hyperventilation and the adherence to Brain Trauma Foundation-Guidelines (BTF-G) after traumatic brain injury (TBI). Setting Twenty-two European centers are participating in the BrainIT initiative. Design Retrospective analysis of monitoring data. Patients and participants One hundred and fifty-one patients with a known time of trauma and at least one recorded arterial blood–gas (ABG) analysis. Measurements and results A total number of 7,703 ABGs, representing 2,269 ventilation episodes(VE) were included in the analysis. Related minute-by-minute ICP data were taken from a 30 min time window around each ABG collection. Data are given as mean with standard deviation. (1) Patients without elevated intracranial pressure (ICP) (\20 mmHg) manifested a statistically significant higher PaCO2(36 ± 5.7 mmHg) in comparison to patients with elevated ICP(C20 mmHg; PaCO2:34 ± 5.4 mmHg, P\0.001). (2) Intensified forced hyperventilation(PaCO2 B 25 mmHg) in the absence of elevated ICP was found in only 49VE (2%). (3) Early prophylactic hyperventilation (\24 h after TBI;PaCO2 B 35 mmHg,ICP\20 mmHg) was used in 1,224VE (54%). (4) During forced hyperventilation(PaCO2 B 30 mmHg), simultaneous monitoring of brain tissue pO2 or SjvO2 was used in only 204 VE (9%). Conclusion While overall adherence to current BTF-Gseems to be the rule, its recommendations on early prophylactic hyperventilation as well as the use of additional cerebral oxygenation monitoring during forced hyperventilation are not followed in this sample of European TBI centers. Descriptor Neurotrauma
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- Piper, I, et al.
(författare)
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The BrainIT group: concept and core dataset definition
- 2003
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Ingår i: Acta Neurochirurgica. - : Springer Science and Business Media LLC. - 0001-6268 .- 0942-0940. ; 145:8, s. 615-629
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Tidskriftsartikel (refereegranskat)abstract
- Introduction. An open collaborative international network has been established which aims to improve inter-centre standards for collection of high-resolution, neurointensive care data on patients with traumatic brain injury. The group is also working towards the creation of an open access, detailed and validated database that will be useful for post-hoc hypothesis testing. In Part A, the underlying concept, the group coordination structure, membership guidelines and database access and publication criteria are described. Secondly, in part B, we describe a set of meetings funded by the EEC that allowed us to define a "Core Dataset" and we present the results of a feasibility exercise for collection of this core dataset. Methods. Four group meetings funded by the EEC have enabled definition of a "Core Dataset" to be collected from all centres regardless of specific project aim. A paper based pilot collection of data was conducted to determine the feasibility for collection of the core dataset. Specially designed forms to collect the core dataset demographic and clinical information as well as sample the time-series data elements were distributed by both email and standard mail to 22 BrainIT centres. A deadline of two months was set to receive completed forms back from centres. A pilot data collection of minute by minute physiological monitoring data was also performed. Findings. A core-dataset was defined and can be downloaded from the BrainIT web-site (go to "Core dataset" link at: www.brainit.org). Eighteen centres (82%) returned completed forms by the set deadline. Overall the feasibility for collection of the core data elements was high with only 10 of the 64 questions (16%) showing missing data. Of those 10 fields with missing data, the average number of centres not responding was 12% and the median 6%. An SQL database to hold the data has been designed and is being tested. Software tools for collection of the core dataset have been developed. Ethics approval has been granted for collection of multi-centre data as part of a pilot data collection study. Interpretation. The BrainIT network provides a more standardised and higher resolution data collection mechanism for research groups, organisations and the device industry to conduct multi-centre trials of new health care technology in patients with traumatic brain injury.
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