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Godoy DA, Videtta W, Santa Cruz R, Silva X, Aguilera-Rodríguez S, Carreño-Rodríguez JN, Ciccioli F, Piñero G, Ciro JD, da Re-Gutiérrez S, Domeniconi G, Fischer D, Hernández O, Lacerda-Gallardo A, Mejía J, Panhke P, Romero C, Lora FS, Soler-Morejón C, Sufan JL, Montes JM, Fuenzalida LC, Parahnos JL, Jibaja M. General care in the management of severe traumatic brain injury: Latin American consensus. Med Intensiva 2020; 44:500-508. [PMID: 32376092 DOI: 10.1016/j.medin.2020.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/16/2019] [Accepted: 01/26/2020] [Indexed: 01/08/2023]
Abstract
Severe traumatic brain injury (sTBI) remains prevalent in the young adult population. Indeed, far from descending, the incidence of sTBI remains high. One of the key bases of treatment is to avoid, detect and correct secondary injuries of systemic origin, which aggravate the primary lesion. Much of this can be achieved by maintaining an adequate physiological microenvironment allowing recovery of the damaged brain tissue. General care measures are nonspecific actions designed to meet that objective. The available guidelines on the management of sTBI have not included the topics contemplated in this consensus. In this regard, a group of members of the Latin American Brain Injury Consortium (LABIC), involved in the different aspects of the acute management of sTBI (neurosurgeons, intensivists, anesthesiologists, neurologists, nurses and physiotherapists) were gathered. An exhaustive literature search was made of selected topics in the LILACS, PubMed, Embase, Scopus, Cochrane Controlled Register of Trials and Web of Science databases. To establish recommendations or suggestions with their respective strength or weakness, the GRADE methodology (Grading of Recommendations, Assessment, Development and Evaluation) was applied. Additionally, certain recommendations (included in complementary material) were not assessed by GRADE, because they constitute a set of therapeutic actions of effective compliance, in which it was not possible to apply the said methodology. Thirty-two recommendations were established, 16 strong and 16 weak, with their respective levels of evidence. This consensus attempts to standardize and establish basic general care measures in this particular patient population.
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Affiliation(s)
- D A Godoy
- Unidad de Cuidados Neurointensivos, Sanatorio Pasteur, San Fernando del Valle de Catamarca, Catamarca, Argentina; Unidad de Cuidados Intensivos, Hospital San Juan Bautista, San Fernando del Valle de Catamarca, Catamarca, Argentina.
| | - W Videtta
- Unidad de Cuidados Intensivos, Hospital Nacional Alejandro Posadas, Unidad de Cuidados Intensivos Hospital Eva Perón, Merlo, Buenos Aires, Argentina
| | - R Santa Cruz
- Unidad de Terapia Intensiva, Hospital Regional Río Gallegos, Río Gallegos, Santa Cruz, Argentina
| | - X Silva
- Escuela de Medicina, Universidad de Magallanes, Punta Arenas, Magallanes, Chile
| | - S Aguilera-Rodríguez
- Servicio Neurocirugía, Hospital Naval Almirante Nef. Viña del Mar, Universidad de Valparaíso, Chile
| | - J N Carreño-Rodríguez
- Unidad de Cuidados Intensivos y Servicio Neurocirugía, Fundación Santa Fe de Bogotá, Universidad del Rosario, Bogotá, Colombia
| | - F Ciccioli
- Unidad Terapia Intensiva, Hospital Municipal de Agudos «Dr. Leónidas Lucero», Universidad Nacional del Sur, Bahía Blanca, Buenos Aires, Argentina
| | - G Piñero
- Unidad Terapia Intensiva, Hospital Municipal de Agudos «Dr. Leónidas Lucero», Universidad Nacional del Sur, Bahía Blanca, Buenos Aires, Argentina
| | - J D Ciro
- Anestesia y Cuidados Intensivos, Clínica Las Américas Auna, Medellín, Antioquia, Colombia
| | - S da Re-Gutiérrez
- Unidad de Terapia Intensiva Adultos, Hospital Materno Infantil C.N.S0, La Paz, Bolivia
| | - G Domeniconi
- Unidad de Cuidados Intensivos, Sanatorio de la Trinidad San Isidro, San Isidro, Buenos Aires, Argentina
| | - D Fischer
- Unidad de Paciente Critico Adulto, Clínica Universidad de los Andes, Santiago de Chile, Chile
| | - O Hernández
- Unidad de Cuidados Intensivos, Clínica Medellín, Medellín, Antioquia, Colombia
| | - A Lacerda-Gallardo
- Departamento de Neurocirugía, Hospital General Docente «Roberto Rodríguez», Morón, Ciego de Ávila, Cuba
| | - J Mejía
- Unidad de Cuidados Neurointensivos, Fundación Valle del Lili, Cali, Valle del Cauca, Colombia
| | - P Panhke
- Shock Room, Hospital Municipal de Urgencias, Córdoba, Argentina
| | - C Romero
- Departamento de Medicina, Unidad de Pacientes Críticos, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - F S Lora
- Universidad Mayor de San Andrés, La Paz, Bolivia
| | - C Soler-Morejón
- Hospital Clínico Quirúrgico «Hermanos Ameijeiras», La Habana, Cuba
| | - J L Sufan
- Unidad de Paciente Neurocrítico, Clínica Indisa, Escuela de Kinesiología, Facultad de Ciencias de la Rehabilitación, Universidad Andres Bello, Santiago, Chile
| | - J M Montes
- Unidad de Paciente Crítico, Clínica Alemana, Santiago de Chile, Chile
| | - L C Fuenzalida
- Departamento Medicina, Pontificia Universidad Católica de Chile, Centro de Pacientes Críticos, Complejo Hospitalario Barros Luco Trudeau, Santiago de Chile, Chile
| | - J L Parahnos
- Unidad de Terapia Intensiva y Servicio de Neurocirugía, Hospital de la Santa Casa, São João del-Rei, Minas Gerais, Brasil
| | - M Jibaja
- Unidad de Cuidados Intensivos, Hospital Eugenio Espejo, Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
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