3.If your hospital is a designated Trauma Centre, what is the designation level? o Level I o Level II o Level III

Transcription

1 Additinal file 1. Prvider prfiling questinnaire GENERAL QUESTIONS 1.What type f hspital is yur hspital? Academic / University hspital Nnacademic hspital Academic / University Hspital = when yur hspital is part f r affiliated t a University. An Academic/University hspital aims nt nly t deliver high-standard patient care, but als cntributes t research and educatin 2.Is yur hspital fficially designated as trauma centre? N Yes N/A in ur cuntry/regin In sme cuntries, hspitals designated as trauma centres are categrized, fr example level 1 r 2 trauma centre. In ther cuntries, these categries d nt apply. If yu live in a cuntry that des nt explicitly designate trauma centres, please select the N/A bx. 3.If yur hspital is a designated Trauma Centre, what is the designatin level? Level I Level II Level III 4. Hw many Intensive Care Unit (ICU) beds des yur hspital have in ttal (excluding beds that are exclusively the crnary care)?.. 5. Des yur hspital have a dedicated neur-intensive care? N Yes 6.Which f the fllwing best describes the mdel f ICU care at yur hspital? Please select ne ptin nly Clsed ICU: critical care physicians (intensivists) assume primary respnsibility fr delivery f intensive care fr Traumatic Brain Injury (TBI) patients. It is pssible here that ther specialists (e.g. a neursurgen) are cnsulted fr advice when deteriratin ccurs. Hwever, the intensivist remains respnsible Open ICU: the admitting surgen (neursurgen / trauma surgen) assumes primary respnsibility fr care f TBI patients, including the prvisin f critical care services. This mdel f care may include elective cnsultatin f an intensivist Mixed: the admitting surgen (neursurgen / trauma surgen) assumes primary respnsibility fr care f TBI patients. A certified physician in critical care (intensivists) crdinates the delivery f care 7.What is the number f Traumatic Brain Injury (TBI) patients treated in yur Intensive Care Unit (ICU) annually? : :..

2 8. With reference t guidelines fr Intensive Care Unit (ICU) management f Traumatic Brain Injury (TBI), des yur ICU: Nt have specific guidelines fr management Fllw the Brain Trauma Fundatin Guidelines Fllw Natinal Guidelines (Please specify: ) Have institutinal guidelines which are bradly based n BTF and/r Natinal Guidelines Have separate guidelines which yu have develped independently (if #4 r #5 abve, please uplad a cpy f yur guidelines) QUESTIONS ABOUT ICP MANAGEMENT ICP mnitring 1. What are indicatins fr ICP mnitring in yur hspital? Please prvide us the general clinical practice at yur center. This des nt have t be the same as stated in the guidelines yu use This questin is abut indicatins fr ICP mnitring in yur center. Select CONSIDERED NOT IMPORTANT IN DECISION MAKING in factrs that are never a reasn fr ICP mnitring. Select ONLY IN THE PRESENCE OF OTHER RISK FACTORS if the factr is never slely a reasn fr ICP mnitring, but it might be a reasn in cmbinatin with ne r mre ther risk factrs. Fr example: a hspital may perfrm ICP mnitring in patients with a GCS 8 withut CT abnrmalities if there are ther risk factrs present. Respndents frm such a hspital shuld tick nly in the presence f ther risk factrs after GCS 8. Select GENERAL POLICY when the criteria are, in general, a reasn fr ICP mnitring in yur hspital. When yu select GENERAL POLICY this must represent a general cnsensus amng clleagues, rather than individual preference. Where yu are in dubt whether this is the apprpriate respnse t the questin, we wuld recmmend, fr example, either a verbal discussin r an exchange with clleagues t check cnsensus. GCS 8 and CT abnrmalities GCS 8 withut CT abnrmalities GCS 9-12 with cntusin Inability t assess a patient with CT Cnsidered nt imprtant in decisin making Only in the presence f ther risk factrs General Plicy

3 abnrmalities clinically (e.g. sedatin, surgery etc.) Intraventricular haemrrhage Other, please specify 2. What are reasns fr NOT mnitring ICP at yur Intensive Care Unit (ICU)? Never (0-10%) Rarely (10-30%) Smetimes (30-70%) Frequently (70-90%) Always (90-100%) Glasgw Cma Scale (GCS) > 8 N radilgical signs f raised ICP Risk f raised ICP cnsidered lw Patient cnsidered unsalvageable Cagulpathy (nn-drug related) Use f anticagulants r platelet aggregatin inhibitrs N device available Nt lcal plicy t mnitr ICP We adhere t a prtcl in which treatment is based n imaging and clinical examinatin T cstly Other, please specify The respnses t this questin shuld represent, as best as practicable, a general cnsensus n treatment at yur center, rather than individual management preferences r pinins. 3. Is there structural variatin between (neur)surgens within yur hspital with regard t the decisin t place an ICP sensr? N Yes Structural variatin refers t a situatin in which ne r mre f the neursurgens are generally mre likely t place an ICP sensr than thers.

4 4. When a patient with plytrauma and minr intracranial pathlgy (which wuld nt therwise indicate ICP mnitring) requires extracranial surgery which is nt life-saving, in the acute phase after trauma, d yu: Place an ICP mnitr and allw surgery t prceed Repeat a CT scan befre/after surgery Undertake a sedatin hld befre and/r after surgery Pstpne surgery if at all pssible Other, please specify.. The respnses t this questin shuld represent, as best as practicable, a general cnsensus n treatment at yur center, rather than individual management preferences. 5. In plytrauma patients with a Glasgw Cma Scale (GCS) >8 and small but nt severe initial CT abnrmalities, wh require mechanical ventilatin fr a number f days because f extracranial injuries, we apply ICP mnitring: Never Only smetimes Often Always The respnses t this questin shuld represent, as best as practicable, a general cnsensus n treatment at yur center, rather than individual management preferences. 6. What kind f ICP sensrs are used in yur hspital? Parenchymal mnitrs withut ptinal ventricular drainage Ventricular catheters Bth Nt applicable since ICP sensrs are nt used 6b. In case yu answered bth in the previus questin: If yu use parenchymal and ventricular catheters in yur hspital, when wuld yu use ventricular/ventricular+ sensr mnitrs (instead f parenchymal mnitring)? please rank the tp 3 reasns: 1:.. 2:. 3:.. Rutine in ur department Nt rutine, but enlarged ventricles External CSF drainage N parenchymal device available Lw cst Other, please specify 6c. If yu use parenchymal and ventricular catheters in yur hspital, when wuld yu use parenchymal mnitrs (instead f ventricular/ventricular+sensr)? 1:.. 2:. 3:..

5 Rutine in ur department Nt rutine, but small ventricles Mainly mtivated by time f day N OR available fr placement ventricular catheter Failed implantatin ventricular cathether Other, please specify.. 6d. When deciding t mnitr ICP we rutinely use additinal ventricular CSF drainage: N, never r seldm As secnd tier therapy t cntrl ICP Only if ventricles are enlarged Yes, always initially 6e. If yu use a ventricular drain: During the use f the ventricular drain, is the drain pen r clsed during the mst f the time? Ventricular drain is pen t drain CSF If this answer ptin is selected: At what level? Ventricular drain is clsed mstly and pened intermittently If this answer ptin is selected: At what pressure is this pened? And fr hw lng? Other, please specify.. Intensive Care Unit (ICU) practice arund ICP mnitring Never (0-10%) Rarely (10-30%) Smetimes (30-70%) 7. Are prphylactic antibitics given prir t ICP mnitr insertin? Frequently (70-90%) Always (90-100%) N/A, we d nt have this technique Ventricular catheter: Parenchymal sensr: 8. Are prphylactic antibitics cntinued after ICP mnitring insertin? Ventricular catheter: Parenchymal sensr 9. Is a Ventricular catheter:

6 cagulatin panel assessed prir t insertin f an ICP mnitring device? Parenchymal sensr 10. What is cnsidered a minimum platelet cunt fr insertin f a ventricular catheter in yur Intensive Care Unit (ICU)? >150K >100K > 80 K >50K Variable, depends n surgen N minimum Other, please specify. 11. What is cnsider the minimum INR fr safe placement f a ventricular catheter in yur Intensive Care Unit (ICU)? <1.4 <1.3 <1.2 Variable, depending n surgen N minimum Other, please specify Wh inserts the catheter/prbes fr ICP mnitring? Please prvide us the general clinical practice at yur center. This des nt have t be the same as stated in the guidelines yu use This questin is abut indicatins fr ICP mnitring in yur center. Select NEVER if the specialism has never inserted ICP mnitrs in TBI patients. Select RARELY / EXCEPTIONAL if the specialism CAN insert ICP mnitrs and des this during exceptinal circumstances (e.g. during the night, crisis, vercrwding). Select GENERAL POLICY when the specialism usually inserts ICP mnitrs. Where yu are in dubt whether this is the apprpriate respnse t the questin, we wuld recmmend, fr example, either a verbal discussin r an exchange with clleagues t check cnsensus. Never Rarely / Exceptinal General Plicy Neursurgen Neursurgical resident Intensivist Intensivist resident Neurintensivist

7 Nn-neursurgical surgen Physician assistant / nurse practitiner Other, please specify. 13. At what level des yur Intensive Care Unit (ICU) zer the ICP catheter? Framen f Mnr Same level as arterial bld pressure Other, please specify 14. At what level des yur Intensive Care Unit (ICU) zer the transducer fr arterial bld pressure (fr calculatin f CPP)? Right atrium Level f arterial catheter Framen f Mnre Other, please specify Hw is the alignment f the transducer t the chsen reference level checked? Nt frmally checked By eye Spirit level Laser indicatin Other (please specify).. 15b. If the level is frmally assessed, is this dne: At admissin Once each day Once per nursing shift Mre frequently CPP mnitring 16. Please list the target Cerebral Perfusin Pressure utilized at yur facility: > 50 mmhg > 60 mmhg > 70 mmhg Individualized 17. Fr treating CPP, which types f IV fluids are used t augment intravascular vlume? Crystallids Cllids starches Cllids - albumin Other cmbinatins

8 18. Which vasactive drugs are used t supprt CPP in patients with Traumatic Brain Injury (TBI)? Vaspressrs Intrpes Other, please specify 19. What mnitring devices are used t titrate vasactive drugs? MAP targets nly Central venus pressure PICCO Lidc Oesphageal Dppler mnitr Pulmnary artery catheter Others, please specify Advanced mnitring 20. Which f the fllwing additinal techniques are utilized at yur Intensive Care Unit (ICU) fr neurmnitring? Never (0-10%) Rarely (10-30%) Smetimes (30-70%) Frequently (70-90%) Always (90-100%) Cerebral micrdialysis Transcranial Dppler CBF prbes Jugular Venus saturatin mnitrs Near infrared mnitrs Brain tissue xygenatin Other, please specify. Treatment f severe Traumatic Brain Injury (TBI) patients at the Intensive Care Unit (ICU) 21. At yur Intensive Care Unit (ICU), the threshld fr medical management f elevated ICP is: > 15 mmhg >20 mmhg >25 mmhg Other, please specify 22. At yur Intensive Care Unit (ICU), the threshld fr perfrming a decmpressive craniectmy in patients with diffuse injury is:

9 > 15 mmhg >20 mmhg >25 mmhg > 30 mm Hg NA. Decmpressive craniectmy is (almst) never perfrmed in ur hspital Sedatin 23. Please rate the utilizatin f the fllwing sedatives, neurmuscular blckers, and analgesics as first line therapies fr ICU management f Traumatic Brain Injury (TBI) patients with increased ICP: Never (0-10%) Rarely (10-30%) Smetimes (30-70%) Frequently (70-90%) Always (90-100%) Fentanyl Midazlam Mrphine (r ther piids) Prpfl Neurmuscular blcking agents Alfa 2 agnist (clnidine r dexmedetmidine) Barbiturates Other, please specify.. Hypersmlar therapy (mannitl and/r hypertnic saline Please prvide us the general clinical practice at yur center. This des nt have t be the same as stated in the guidelines yu use This questin is abut the use f hypersmtic therapy in patients with elevated ICP. Select NEVER in agents that are never used in yur center. Select RARELY / EXCEPTIONAL in agents that can be used but are n general plicy. Select GENERAL POLICY when the agent is, in general, used t treat elevated ICP in yur center. When yu select GENERAL POLICY this must represent a general cnsensus amng clleagues, rather than individual preference. Where yu are in dubt whether this is the apprpriate respnse t the questin, we wuld recmmend, fr example, either a verbal discussin r an exchange with clleagues t check cnsensus. 24. Is mannitl utilized t treat patients with increased ICP in yur ICU? Never Rarely / Exceptinal General Plicy 25. Is hypertnic saline

10 utilized t treat patients with increased ICP in yur ICU? 26. Is hypertnic saline administered in cnjunctin with mannitl? Mannitl and Hypertnic Saline 27. Hw are these agents administered? 28. If administered in fixed blus dses, hw frequently is it given: Mannitl N/A Dse titrated t ICP Fixed Blus dsing Standard cntinuus infusin N/A Mre ften than 6 times per day 6 times per day (every 4 hurs) 4 times per day (every 6 hurs) Less than 4 times per day Other, please specify.. If mannitl is administered, is serum smlarity mnitred? N/A N Yes If yes, an upper limit f mosm/liter Hypertnic saline N/A Dse titrated t ICP Fixed Blus dsing Standard cntinuus infusin N/A Mre ften than 6 times per day 6 times per day (every 4 hurs) 4 times per day (every 6 hurs) Less than 4 times per day Other, please specify. If hypertnic saline is administered as a cntinuus infusin, is there a serum sdium gal? N/A N Yes If yes, a gal f.(meq/l) The respnses t this questin shuld represent, as best as practicable, a general cnsensus n treatment at yur center, rather than individual management preferences.

11 Secnd/third tier therapies fr treatment f raised intracranial pressure The respnses t the fllwing questins shuld represent, as best as practicable, a general cnsensus n treatment at yur center, rather than individual management preferences. 29a. Are the fllwing appraches used t treat refractry intracranial hypertensin? Decmpressive craniectmy Hypthermia (temperature < 36 degrees Celsius) Intensive hyperventilatin (PCO2 < 4.0 kpa) Never (0-10%) Rarely (10-30%) Smetimes (30-70%) Frequently (70-90%) Always (90-100%) Barbiturates 29b. If hyperventilatin is answered with rarely always: When is hyperventilatin (PaCO2 < 4,0 kpa)) utilized in Traumatic Brain Injury (TBI) patients at the intensive care unit? Never (0- Rarely (10- Smetimes (30- Frequently Always prphylactic hyperventilatin (PaCO2 < 35 mmhg) T manage intracranial pressure fr less than six hurs T manage intracranial pressure fr mre than six hurs In cases f imminent herniatin Is brain tissue xygen mnitring (PbtO2) used t measure cerebral xygenatin during hyperventilatin? 10%) 30%) 70%) (70-90%) (90-100%) 29c. If hyperventilatin is used, what is the target PaCO2 (as secnd/third tier therapy)? <35 mmhg <30 mmhg <25 mmhg Variable, dependent n patient Variable, dependent n surgen/intensivist

12 29d. If hypthermia is used, what is the target temperature? > r Variable depending n patient Variable depending n physician 29e. If barbiturates are used, hw is the dse targeted? Cntinuus EEG mnitring Intermittent EEG recrding Serum levels EEG and serum levels ICP cntrl ICP cntrl and EEG