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dc.contributor.authorHuijben, Jilske A.
dc.contributor.authorDixit, Abhishek
dc.contributor.authorStocchetti, Nino
dc.contributor.authorMaas, Andrew I. R.
dc.contributor.authorLingsma, Hester F.
dc.contributor.authorvan der Jagt, Mathieu
dc.contributor.authorNelson, David
dc.contributor.authorCiterio, Giuseppe
dc.contributor.authorWilson, Lindsay
dc.contributor.authorMenon, David K.
dc.contributor.authorErcole, Ari
dc.contributor.authorAndelic, Nada
dc.contributor.authorAndreassen, Lasse
dc.contributor.authorAnke, Audny Gabriele Wagner
dc.contributor.authorFrisvold, Shirin
dc.contributor.authorHelseth, Eirik
dc.contributor.authorRøe, Cecilie
dc.contributor.authorRøise, Olav
dc.contributor.authorSkandsen, Toril
dc.contributor.authorVik, Anne
dc.contributor.authorÅkerlund, Cecilia
dc.contributor.authorAmrein, Krisztina
dc.contributor.authorAntoni, Anna
dc.contributor.authorAudibert, Gerard
dc.contributor.authorAzouvi, Philippe
dc.contributor.authorAzzolini, Maria luisa
dc.contributor.authorBartels, Ronald
dc.contributor.authorBarzo, Pal
dc.contributor.authorBeauvais, Romuald
dc.contributor.authorBeer, Ronny
dc.contributor.authorBellander, Bo-michael
dc.contributor.authorBelli, Antonio
dc.contributor.authorBenali, Habib
dc.contributor.authorBerardino, Maurizio
dc.contributor.authorBeretta, Luigi
dc.contributor.authorBlaabjerg, Morten
dc.contributor.authorBragge, Peter
dc.contributor.authorBrazinova, Alexandra
dc.contributor.authorBrinck, Vibeke
dc.contributor.authorBrooker, Joanne
dc.contributor.authorBrorsson, Camilla
dc.contributor.authorBuki, Andras
dc.contributor.authorBullinger, Monika
dc.contributor.authorCabeleira, Manuel
dc.contributor.authorCaccioppola, Alessio
dc.contributor.authorCalappi, Emiliana
dc.contributor.authorCalvi, Maria rosa
dc.contributor.authorCameron, Peter
dc.contributor.authorLozano, Guillermo carbayo
dc.contributor.authorCarbonara, Marco
dc.contributor.authorChevallard, Giorgio
dc.contributor.authorChieregato, Arturo
dc.contributor.authorCiterio, Giuseppe
dc.contributor.authorCnossen, Maryse
dc.contributor.authorCoburn, Mark
dc.identifier.citationCritical Care. 2021, 25 (78), .en_US
dc.description.abstractPurpose To study variation in, and clinical impact of high Therapy Intensity Level (TIL) treatments for elevated intracranial pressure (ICP) in patients with traumatic brain injury (TBI) across European Intensive Care Units (ICUs). Methods We studied high TIL treatments (metabolic suppression, hypothermia (< 35 °C), intensive hyperventilation (PaCO2 < 4 kPa), and secondary decompressive craniectomy) in patients receiving ICP monitoring in the ICU stratum of the CENTER-TBI study. A random effect logistic regression model was used to determine between-centre variation in their use. A propensity score-matched model was used to study the impact on outcome (6-months Glasgow Outcome Score-extended (GOSE)), whilst adjusting for case-mix severity, signs of brain herniation on imaging, and ICP. Results 313 of 758 patients from 52 European centres (41%) received at least one high TIL treatment with significant variation between centres (median odds ratio = 2.26). Patients often transiently received high TIL therapies without escalation from lower tier treatments. 38% of patients with high TIL treatment had favourable outcomes (GOSE ≥ 5). The use of high TIL treatment was not significantly associated with worse outcome (285 matched pairs, OR 1.4, 95% CI [1.0–2.0]). However, a sensitivity analysis excluding high TIL treatments at day 1 or use of metabolic suppression at any day did reveal a statistically significant association with worse outcome. Conclusion Substantial between-centre variation in use of high TIL treatments for TBI was found and treatment escalation to higher TIL treatments were often not preceded by more conventional lower TIL treatments. The significant association between high TIL treatments after day 1 and worse outcomes may reflect aggressive use or unmeasured confounders or inappropriate escalation strategies. Take home message Substantial variation was found in the use of highly intensive ICP-lowering treatments across European ICUs and a stepwise escalation strategy from lower to higher intensity level therapy is often lacking. Further research is necessary to study the impact of high therapy intensity treatments.en_US
dc.rightsNavngivelse 4.0 Internasjonal*
dc.titleUse and impact of high intensity treatments in patients with traumatic brain injury across Europe: a CENTER-TBI analysisen_US
dc.typePeer revieweden_US
dc.typeJournal articleen_US
dc.source.journalCritical Careen_US

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Navngivelse 4.0 Internasjonal
Except where otherwise noted, this item's license is described as Navngivelse 4.0 Internasjonal