Preserve encephalus in surgery of trauma: online survey. (P.E.S.T.O)

World Journal of Emergency Surgery

Philip F. Stahel¹  Vanni Agnoletti²  Sandra Rossi³  Edoardo Picetti³  Gian Luca Baiocchi⁴  Fausto Catena⁵  Yoram Kluger⁶  Luca Ansaloni⁷  Ronald V. Maier⁸  Ernest E. Moore⁹  Andrew W. Kirkpatrick^1,10  Walter L. Biffl^1,11 

[1] College of Osteopathic Medicine, Rocky Vista University;Department of Anesthesia and Intensive Care, Bufalini Hospital;Department of Anesthesia and Intensive Care, Parma University Hospital;Department of Clinical and Experimental Sciences, University of Brescia;Department of Emergency Surgery, Parma University Hospital;Department of General Surgery, Rambam Health Campus;Department of General and Emergency Surgery, Bufalini Hospital;Department of Surgery, Harborview Medical Center;Department of Trauma Surgery, Denver Health;Departments of General Acute Care, Abdominal Wall Reconstruction and Trauma Surgery, Foothills Medical Centre;Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital;

关键词: Traumatic brain injury;    Polytrauma;    Management;    Monitoring;   

DOI  :  10.1186/s13017-019-0229-2

来源: DOAJ

【 摘 要 】

Abstract Background Traumatic brain injury (TBI) is a global health problem. Extracranial hemorrhagic lesions needing emergency surgery adversely affect the outcome of TBI. We conducted an international survey regarding the acute phase management practices in TBI polytrauma patients. Methods A questionnaire was available on the World Society of Emergency Surgery website between December 2017 and February 2018. The main endpoints were the evaluation of (1) intracranial pressure (ICP) monitoring during extracranial emergency surgery (EES), (2) hemodynamic management without ICP monitoring during EES, (3) coagulation management, and (4) utilization of simultaneous multisystem surgery (SMS). Results The respondents were 122 representing 105 trauma centers worldwide. ICP monitoring was utilized in 10–30% of patients at risk of intracranial hypertension (IH) undergoing EES from about a third of the respondents [n = 35 (29%)]. The respondents reported that the safest values of systolic blood pressure during EES in patients at risk of IH were 90–100 mmHg [n = 35 (29%)] and 100–110 mmHg [n = 35 (29%)]. The safest values of mean arterial pressure during EES in patients at risk of IH were > 70 mmHg [n = 44 (36%)] and > 80 mmHg [n = 32 (26%)]. Regarding ICP placement, a large percentage of respondents considered a platelet (PLT) count > 50,000/mm3 [n = 57 (47%)] and a prothrombin time (PT)/activated partial thromboplastin time (aPTT) < 1.5 times the normal control [n = 73 (60%)] to be the safest parameters. For craniotomy, the majority of respondents considered PLT count > 100,000/mm3 [n = 67 (55%)] and a PT/aPTT < 1.5 times the normal control [n = 76 (62%)] to be the safest parameters. Almost half of the respondents [n = 53 (43%)], reported that they transfused red blood cells (RBCs)/plasma (P)/PLTs at a ratio of 1/1/1 in TBI polytrauma patients. SMS was performed in 5–19% of patients, requiring both an emergency neurosurgical operation and EES, by almost half of the respondents [n = 49 (40%)]. Conclusions A great variability in practices during the acute phase management of polytrauma patients with severe TBI was identified. These findings may be helpful for future investigations and educational purposes.

【 授权许可】

Unknown