• Randall Chesnut, Sergio Aguilera, Andras Buki, Eileen Bulger, Giuseppe Citerio, D Jamie Cooper, Ramon Diaz Arrastia, Michael Diringer, Anthony Figaji, Guoyi Gao, Romer Geocadin, Jamshid Ghajar, Odette Harris, Alan Hoffer, Peter Hutchinson, Mathew Joseph, Ryan Kitagawa, Geoffrey Manley, Stephan Mayer, David K Menon, Geert Meyfroidt, Daniel B Michael, Mauro Oddo, David Okonkwo, Mayur Patel, Claudia Robertson, Jeffrey V Rosenfeld, Andres M Rubiano, Juan Sahuquillo, Franco Servadei, Lori Shutter, Deborah Stein, Nino Stocchetti, Fabio Silvio Taccone, Shelly Timmons, Eve Tsai, Jamie S Ullman, Paul Vespa, Walter Videtta, David W Wright, Christopher Zammit, and Hawryluk Gregory W J GWJ 0000-0002-5604-7057 Section of Neurosurgery, University of Manitoba, GB1, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
• Department of Neurological Surgery, Harborview Medical Center, University of Washington, 325 Ninth Ave, Mailstop 359766, Seattle, Washington, 98104-2499, USA.
• Intensive Care Med. 2020 May 1; 46 (5): 919-929.

BackgroundCurrent guidelines for the treatment of adult severe traumatic brain injury (sTBI) consist of high-quality evidence reports, but they are no longer accompanied by management protocols, as these require expert opinion to bridge the gap between published evidence and patient care. We aimed to establish a modern sTBI protocol for adult patients with both intracranial pressure (ICP) and brain oxygen monitors in place.MethodsOur consensus working group consisted of 42 experienced and actively practicing sTBI opinion leaders from six continents. Having previously established a protocol for the treatment of patients with ICP monitoring alone, we addressed patients who have a brain oxygen monitor in addition to an ICP monitor. The management protocols were developed through a Delphi-method-based consensus approach and were finalized at an in-person meeting.ResultsWe established three distinct treatment protocols, each with three tiers whereby higher tiers involve therapies with higher risk. One protocol addresses the management of ICP elevation when brain oxygenation is normal. A second addresses management of brain hypoxia with normal ICP. The third protocol addresses the situation when both intracranial hypertension and brain hypoxia are present. The panel considered issues pertaining to blood transfusion and ventilator management when designing the different algorithms.ConclusionsThese protocols are intended to assist clinicians in the management of patients with both ICP and brain oxygen monitors but they do not reflect either a standard-of-care or a substitute for thoughtful individualized management. These protocols should be used in conjunction with recommendations for basic care, management of critical neuroworsening and weaning treatment recently published in conjunction with the Seattle International Brain Injury Consensus Conference.

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