Consensus-Based Management Protocol (CREVICE Protocol) for the Treatment of Severe Traumatic Brain Injury Based on Imaging and Clinical Examination for Use When Intracranial Pressure Monitoring Is Not Employed

• DOI: 10.1089/neu.2017.5599
• Publication Date: 2020-02-04T12:39:58Z
• Authors: Randall M. Chesnut; Nancy Temkin; Walter Videtta; Gustavo Petroni; Silvia Lujan; Jim Pridgeon; Sureyya Dikmen; Kelley Chaddock; Jason Barber; Joan Machamer; Nahuel Guadagnoli; Peter Hendrickson; Sergio Aguilera; Victor Alanis; Manuel Enrique Be...; Ermitaño Bautista...; Luis Alberto Bust...; Armando C. Caccia...; Carlos Javier Car...; Felipe Carvajal; Rafael Davila; Mario Dominguez; Jairo Antonio Fig...; Maria Martha Fillipi; Daniel A. Godoy; Delia Cristina Gomez; Angel J. Lacerda ...; Juan Antonio Guer...; Gustavo la Fuente...; Luis Arturo Lavad...; Cecilio Lequipe; Gerardo Vicente G...; Manuel Jibaja Vega; Michael Eduardo K...; Hubiel J. López D...; Freddy Sandi Lora; Ana Maria Mazzola; Roberto Merida Ma...; Natascha Mezquia ...; J. Ricardo Martín...; Julio C. Mijangos...; Jacobo Mora; Johnny Marcelo Oc...; Perla B. Pahnke; Jorge Paranhos; Gustavo R. Piñero; Francisco A. Riva...; Mario Napoleon Me...; Ricardo Luis Rome...; Andres M. Rubiano; Alexandra Matilde...; Juan Ignacio Sile...; Luis Silva Naranjo; Caridad Soler Mor...; Zulma Urbina
• Keywords: Intracranial pressure monitoring

Globally, intracranial pressure (ICP) monitoring use in severe traumatic brain injury (sTBI) is inconsistent and susceptible to resource limitations clinical philosophies. For situations without monitoring, there no published comprehensive management algorithm specific identifying treating suspected hypertension (SICH) outside of the one ad hoc Imaging Clinical Examination (ICE) protocol Benchmark Evidence from South American Trials: Treatment Intracranial Pressure (BEST:TRIP) trial. As part an ongoing National Institutes Health (NIH)-supported project, a consensus conference involving 43 experienced Latin Intensivists Neurosurgeons who routinely care for sTBI patients ICP refined, revised, augmented original BEST:TRIP algorithm. Based on trial data pre-meeting polling, 11 issues were targeted development. We used Delphi-based methodology codify individual statements final algorithm, using group agreement threshold 80%. The resulting CREVICE (Consensus REVised ICE) defines SICH addresses both general treatment. treatment modalities are organized into tiers guide escalation tapering. schedules developed facilitate disease severity. A decision-support model, based group's combined practices, provided this process. This provides first when not available. It intended provide framework direct future research toward management. Because dearth relevant literature, it explicitly based, solely as (a "consensus-based curbside consult") assist intensive units resource-limited environments.