Fluid balance and outcome in critically ill patients with traumatic brain injury (CENTER-TBI and OzENTER-TBI): a prospective, multicentre, comparative effectiveness study

Cooper, David J.; Moore, Elizabeth; Dippel, Diederik W.J.; Brooker, Joanne; Bragge, Peter; Helbok, Raimund; Beer, Ronny; Schöechl, Herbert; Rusňák, Martin; Schwendenwein, Elisabeth; Antoni, Anna; Keyser, Véronique De; Menovsky, Tomas; Praag, Dominique Van; Maas, Andrew I. R.; Steen, Gregory Van der; Parizel, Paul M.; Vyvere, Thijs Vande; Depreitere, Bart; Hecke, Wim Van; Verheyden, Jan; Benoît, Michel; Ledoux, Didier; Laureys, Steven; Ghuysen, Alexandre; Maréchal, Hugues; Dulière, Guy‐Loup; Gao, Guoyi; Jiang, Jiyao; Kondziella, Daniel; Fabricius, Martin; Schou, Rico Frederik; Blaabjerg, Morten; Rosenlund, Christina; Piippo-Karjalainen, Anna; Raj, Rahul; Pirinen, Matti; Ripatti, Samuli; Ylén, Peter; Posti, Jussi P.; Tenovuo, Olli; Takala, Riikka; Payen, Jean‐François; Vega, Emmanuel; Lejeune, Aurélie; Audibert, Gérard; Degos, Vincent; Benali, Habib; Galanaud, Damien; Perlbarg, Vincent; Puybasset, Louis; Azouvi, Philippe; Legrand, Valérie; Dahyot‐Fizelier, Claire; Rossaint, Rolf; Coburn, Mark; Kowark, Ana; Clusmann, Hans; Dreier, Jens P.; Wolf, Stefan; Vajkoczy, Peter; Maegele, Marc; Gratz, Johannes; Schäfer, Nadine; Lefering, Rolf; Čović, Amra; Steinbüchel, Nicole von; Schmidt, Silke; Bullinger, Monika; Younsi, Alexander; Unterberg, Andreas; Mattern, Julia; Sakowitz, Oliver; Sánchez-Porras, Renán; Perera, Natascha; Beauvais, Romuald; Sándor, János; Czeiter, Endre; Büki, András; Ezer, Erzsébet; Vámos, Zoltán; Melegh, Béla; Tamás, Viktória; Sorinola, Abayomi; Kovács, Noémi; Nyirádi, József; Amrein, Krisztina; Barzó, Pál; Gupta, Deepak; Levi, Leon; Rosenthal, Guy; Furmanov, Alex; Martino, Costanza; Beretta, Luigi; Calvi, Maria Rosa; Azzolini, Maria Luisa; Stocchetti, Nino; Calappi, Emiliana; Zoerle, Tommaso; Ortolano, Fabrizio; Carbonara, Marco; Caccioppola, Alessio; Vargiolu, Alessia; Citerio, Giuseppe; Chieregato, Arturo; Chevallard, Giorgio; Corte, Francesco Della; Grossi, Francesca; Rossi, Sandra; Persona, Paolo; Berardino, Maurizio; Cavallo, Simona; Rambadagalla, Malinka; Ziverte, Agate; Giga, Lelde; Valeinis, Egils; Vilcinis, Rimantas; Tamošuitis, Tomas; Ročka, Saulius; Ragauskas, Arminas; Naalt, Joukje van der; Jacobs, Bram; Bartels, Ronald; Boogert, Hugo den; Kompanje, Erwin J. O.; Timmers, Marjolijn; Foks, Kelly; Haitsma, Iain; Volovici, Victor; Jagt, Mathieu van der; Haagsma, Juanita A.; Mikolić, Ana; Lingsma, Hester F.; Velt, Kimberley; Huijben, Jilske; Voormolen, Daphne; Nieboer, Daan; Wiegers, Eveline; Sewalt, Charlie; Gravesteijn, Benjamin; Polinder, Suzanne; Steyerberg, Ewout W.; Tibboel, Dick; Wijk, R. Van; Dijck, Jeroen T.J.M. van; Essen, Thomas A. van; Peul, Wilco C.; Schoonman, Guus; Jones, Kelly; Feigin, Valery; Ao, Braden Te; Theadom, Alice; Helseth, Eirik; Røe, Cecilie; Røise, Olav; Anđelić, Nada; Frisvold, Shirin; Andreassen, Lasse; Anke, Audny; Vik, Anne; Skandsen, Toril; Pleș, Horia; Tudora, Cristina Maria; Negru, Ancuta; Vulekovic, Peter; Đilvesi, Đula; Karan, Mladen; Golubović, Jagoš; Rehorčíková, Veronika; Taylor, Mark; Bražinová, Alexandra; Majdán, Marek; Sahuquillo, Juan; Rădoi, Andreea; Lozano, Guillermo Carbayo; Pomposo, Iñigo; Lagares, Alfonso; Gomez, Pedro A.; Castaño‐León, Ana M.; Gagliardo, Pablo; Orešič, Matej; Bellander, Bo‐Michael; Lanyon, Linda; George, Pradeep; Muraleedharan, Visakh; Nelson, David W.; Ackerlund, Cecilia; Koskinen, Lars‐Owe D.; Sundström, Nina; Brorsson, Camilla; Belli, Antonio; Manara, Alex; Thomas, Matt; Czosnyka, Marek; Smielewski, Peter; Cabeleira, Manuel; Coles, Jonathan P.; Richardson, Sylvia; Zeiler, Frederick A.; Stamatakis, Emmanuel A.; Williams, Guy; Menon, David; Ercole, Ari; Dixit, Abhishek; Newcombe, Virginia; Richter, Sophie; McFadyen, Charles; Hutchinson, Peter J.; Kolias, Angelos; Adams, Hadie; Correia, Marta; Rhodes, Jonathan R.; Stewart, William; McMahon, Catherine; Rueckert, Daniel; Glocker, Ben; Tolias, Christos M.; Dawes, Helen; Esser, Patrick; Heugten, Caroline van; Curry, Nicola; Stanworth, Simon; Lecky, Fiona; Olubukola, Otesile; Johnson, Faye; Dark, Paul; Jankowski, Stefan; Lightfoot, Roger; Wilson, Lindsay; Horton, Lindsay; Stevens, Robert; Palotie, Aarno; Rosand, Jonathan; Manley, Geoffrey T.; Jarrett, Mike; Brinck, Vibeke; Wang, Kevin; Yang, Zhihui; Vespa, Paul; Gruen, Russell L.; Cameron, Peter; Donoghue, Emma; Cooper, Jamie D.; Gantner, Dashiell; Gruen, R.; Murray, Lynette J.; Rosenfeld, Jeffrey V.; Varma, Dinesh; Trapani, Tony; Vallance, Shirley; MacIsaac, Cristopher; Jordan, Andrea

doi:10.1016/s1474-4422(21)00162-9

Cited by 53 publications

(29 citation statements)

References 30 publications

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“…The most notable distinction relates to hemodynamic management; in polytrauma patients with moderate-severe TBI, “permissive arterial hypotension” should be aggressively avoided, while this strategy is highly recommended in polytrauma patients without TBI. A recent study showed that positive fluid balances were associated with worse outcomes in TBI patients, suggesting that normovolemia should be the target in this setting [ 98 ]. In this regard, the utilization of advanced hemodynamic monitoring to assess cardiac output or fluid responsiveness (i.e., stroke volume variation, pulse pressure variation, etc.)…”

Section: Discussionmentioning

confidence: 99%

Perioperative Management of Polytrauma Patients with Severe Traumatic Brain Injury Undergoing Emergency Extracranial Surgery: A Narrative Review

Picetti

Rosenstein

Balogh

et al. 2021

JCM

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Managing the acute phase after a severe traumatic brain injury (TBI) with polytrauma represents a challenging situation for every trauma team member. A worldwide variability in the management of these complex patients has been reported in recent studies. Moreover, limited evidence regarding this topic is available, mainly due to the lack of well-designed studies. Anesthesiologists, as trauma team members, should be familiar with all the issues related to the management of these patients. In this narrative review, we summarize the available evidence in this setting, focusing on perioperative brain protection, cardiorespiratory optimization, and preservation of the coagulative function. An overview on simultaneous multisystem surgery (SMS) is also presented.

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Section: Discussionmentioning

confidence: 99%

Perioperative Management of Polytrauma Patients with Severe Traumatic Brain Injury Undergoing Emergency Extracranial Surgery: A Narrative Review

Picetti

Rosenstein

Balogh

et al. 2021

JCM

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“…However, fluid balance does not always reflect intravascular volume status. Hypervolemia can augment cerebral edema in patients with blood–brain barrier (BBB) disruption, exacerbate heart failure, cardiogenic shock, and pulmonary edema, and is also associated with high ICU mortality and worse outcomes in SABI [ 133 , 136 , 137 ]. Guidelines recommend targeting intravascular euvolemia and avoiding a restrictive or negative fluid balance in SABI [ 138 ].…”

Section: Management Of Brain-lung Conflicts In Concurrent Sabi and Ardsmentioning

confidence: 99%

Brain-Lung Crosstalk: Management of Concomitant Severe Acute Brain Injury and Acute Respiratory Distress Syndrome

Matin

Sarhadi

Crooks

et al. 2022

Curr Treat Options Neurol

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Purpose of Review To summarize pathophysiology, key conflicts, and therapeutic approaches in managing concomitant severe acute brain injury (SABI) and acute respiratory distress syndrome (ARDS). Recent Findings ARDS is common in SABI and independently associated with worse outcomes in all SABI subtypes. Most landmark ARDS trials excluded patients with SABI, and evidence to guide decisions is limited in this population. Potential areas of conflict in the management of patients with both SABI and ARDS are (1) risk of intracranial pressure (ICP) elevation with high levels of positive end-expiratory pressure (PEEP), permissive hypercapnia due to lung protective ventilation (LPV), or prone ventilation; (2) balancing a conservative fluid management strategy with ensuring adequate cerebral perfusion, particularly in patients with symptomatic vasospasm or impaired cerebrovascular blood flow; and (3) uncertainty about the benefit and harm of corticosteroids in this population, with a mortality benefit in ARDS, increased mortality shown in TBI, and conflicting data in other SABI subtypes. Also, the widely adapted partial pressure of oxygen (P a O 2 ) target of > 55 mmHg for ARDS may exacerbate secondary brain injury, and recent guidelines recommend higher goals of 80–120 mmHg in SABI. Distinct pathophysiology and trajectories among different SABI subtypes need to be considered. Summary The management of SABI with ARDS is highly complex, and conventional ARDS management strategies may result in increased ICP and decreased cerebral perfusion. A crucial aspect of concurrent management is to recognize the risk of secondary brain injury in the individual patient, monitor with vigilance, and adjust management during critical time windows. The care of these patients requires meticulous attention to oxygenation and ventilation, hemodynamics, temperature management, and the neurological exam. LPV and prone ventilation should be utilized, and supplemented with invasive ICP monitoring if there is concern for cerebral edema and increased ICP. PEEP titration should be deliberate, involving measures of hemodynamic, pulmonary, and brain physiology. Serial volume status assessments should be performed in SABI and ARDS, and fluid management should be individualized based on measures of brain perfusion, the neurological exam, and cardiopulmonary status. More research is needed to define risks and benefits in corticosteroids in this population.

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“…However, this must be balanced with maintaining a neutral fluid balance and avoiding hyponatremia and worsening cerebral edema. 54 There has been an ongoing debate over the optimal crystalloid due to insufficient evidence concerning different aspects: how much volume should be given, does using a bolus versus infusion affect mortality rates, and whether the solution used should be hypertonic or isotonic. The initiative to compare crystalloid with colloid resuscitation for TBI has lost momentum since the publication of the Saline versus Albumin Fluid Evaluation (SAFE) trial in 2007.…”

Section: Circulation: the Optimal Resuscitation Fluidmentioning

confidence: 99%

Controversies and evidence gaps in the early management of severe traumatic brain injury: back to the ABCs

El-Swaify

Refaat

Ali

et al. 2022

Trauma Surg Acute Care Open

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Traumatic brain injury (TBI) accounts for around 30% of all trauma-related deaths. Over the past 40 years, TBI has remained a major cause of mortality after trauma. The primary injury caused by the injurious mechanical force leads to irreversible damage to brain tissue. The potentially preventable secondary injury can be accentuated by addressing systemic insults. Early recognition and prompt intervention are integral to achieve better outcomes. Consequently, surgeons still need to be aware of the basic yet integral emergency management strategies for severe TBI (sTBI). In this narrative review, we outlined some of the controversies in the early care of sTBI that have not been settled by the publication of the Brain Trauma Foundation’s 4th edition guidelines in 2017. The topics covered included the following: mode of prehospital transport, maintaining airway patency while securing the cervical spine, achieving adequate ventilation, and optimizing circulatory physiology. We discuss fluid resuscitation and blood product transfusion as components of improving circulatory mechanics and oxygen delivery to injured brain tissue. An outline of evidence-based antiplatelet and anticoagulant reversal strategies is discussed in the review. In addition, the current evidence as well as the evidence gaps for using tranexamic acid in sTBI are briefly reviewed. A brief note on the controversial emergency surgical interventions for sTBI is included. Clinicians should be aware of the latest evidence for sTBI. Periods between different editions of guidelines can have an abundance of new literature that can influence patient care. The recent advances included in this review should be considered both for formulating future guidelines for the management of sTBI and for designing future clinical studies in domains with clinical equipoise.

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Fluid balance and outcome in critically ill patients with traumatic brain injury (CENTER-TBI and OzENTER-TBI): a prospective, multicentre, comparative effectiveness study

Cited by 53 publications

References 30 publications

Perioperative Management of Polytrauma Patients with Severe Traumatic Brain Injury Undergoing Emergency Extracranial Surgery: A Narrative Review

Perioperative Management of Polytrauma Patients with Severe Traumatic Brain Injury Undergoing Emergency Extracranial Surgery: A Narrative Review

Brain-Lung Crosstalk: Management of Concomitant Severe Acute Brain Injury and Acute Respiratory Distress Syndrome

Controversies and evidence gaps in the early management of severe traumatic brain injury: back to the ABCs

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