Intracranial multimodal monitoring in neurocritical care (Neurocore-iMMM): an open, decentralized consensus

IF 8.8 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Pub Date : 2024-12-20 DOI:10.1186/s13054-024-05211-8

Sami Barrit, Mejdeddine Al Barajraji, Salim El Hadwe, Alexandre Niset, Brandon Foreman, Soojin Park, Christos Lazaridis, Lori Shutter, Brian Appavu, Matthew P. Kirschen, Felipe A. Montellano, Verena Rass, Nathan Torcida, Daniel Pinggera, Emily Gilmore, Nawfel Ben-Hamouda, Nicolas Massager, Francis Bernard, Chiara Robba, Fabio Silvio Taccone

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引用次数: 0

Abstract

Intracranial multimodal monitoring (iMMM) is increasingly used in neurocritical care, but a lack of standardization hinders its evidence-based development. Here, we devised core outcome sets (COS) and reporting guidelines to harmonize iMMM practices and research. An open, decentralized, three-round Delphi consensus study involved experts between December 2023 and June 2024. Items—spanning three domains: (i) patient characteristics, (ii) practices, and (iii) outcomes—with ≥ 75% agreement were classified as strong agreement, while those with 50–75% were reconsidered in subsequent rounds, requiring ≥ 66% for moderate agreement. An international, multidisciplinary panel comprised 58 neurocritical physicians and researchers with low attrition (12%). They were predominantly from Western regions (96%), actively involved in iMMM (82%), at least weekly (72.4%), with more than 10 years of specific experience (57%). Of the 127 items assessed for inclusion in COS and reporting guidelines, 45 (35.4%) reached strong and 8 (6.3%) moderate agreement. Main strong agreement items were: (i) demographics: age (98%) and sex/gender (90%); comorbidities: coagulation/platelet disorders (95%); initial scoring: Glasgow Coma Scale (97%) and pathology-specific scores (90%); active treatments: antithrombotics (95%) (ii) clinical practice: iMMM implantation indications (98%) and iMMM-guided interventions (91%); surgical practice: targeting strategies (97%) and concomitant external ventricular drainage (97%); technical details: recording modalities (98%); (iii) monitoring parameters: duration (97%) and triggered interventions (95%); standardized outcome reporting (93%); surgical complications (e.g., postoperative intracranial hemorrhages, CNS infections, and probe misplacement, all > 90%) and adverse events (accidental dislodgement, probe breakage, and technical malfunctions, all > 90%). This consensus establishes foundational COS and reporting guidelines for iMMM in neurocritical care. These harmonization tools can enhance research quality, comparability, and reproducibility, facilitating evidence-based practices for this emerging technology. However, challenges remain in developing purpose-specific guidelines and adapting them to diverse clinical and research settings.

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神经重症监护中的颅内多模态监测（Neurocore-iMMM）：开放、分散的共识

颅内多模态监护（iMMM）在神经重症监护中的应用越来越广泛，但标准化的缺乏阻碍了其循证发展。在此，我们设计了核心结果集（COS）和报告指南，以统一 iMMM 的实践和研究。在 2023 年 12 月至 2024 年 6 月期间，专家们参与了一项开放、分散、三轮德尔菲共识研究。研究项目涵盖三个领域：(i) 患者特征、(ii) 实践和 (iii) 结果--如果达成一致的比例≥75%，则被归类为高度一致；如果达成一致的比例为 50%-75%，则在随后的几轮研究中重新考虑，要求达成一致的比例≥66% 为中度一致。国际多学科小组由 58 名神经重症医生和研究人员组成，自然减员率低（12%）。他们主要来自西部地区（96%），积极参与 iMMM（82%），至少每周一次（72.4%），有 10 年以上的具体经验（57%）。在为纳入 COS 和报告指南而评估的 127 个项目中，45 个项目（35.4%）达成了高度一致，8 个项目（6.3%）达成了中度一致。主要高度一致的项目有(i) 人口统计学：年龄（98%）和性别（90%）；合并症：凝血/血小板障碍（95%）；初始评分：(ii) 临床实践：iMMM 植入适应症（98%）和 iMMM 引导的干预（91%）；手术实践：靶向策略（97%）和同时进行的心室外引流（97%）；技术细节：记录方式（98%）；(iii) 监测参数：持续时间（97%）和触发干预（95%）；标准化结果报告（93%）；手术并发症（如g.,手术并发症（如术后颅内出血、中枢神经系统感染和探针错位，均大于 90%）和不良事件（意外脱落、探针断裂和技术故障，均大于 90%）。该共识为神经重症监护中的 iMMM 制定了基本的 COS 和报告指南。这些协调工具可以提高研究质量、可比性和可重复性，促进这一新兴技术的循证实践。然而，在制定特定目的的指南并使其适用于不同的临床和研究环境方面仍存在挑战。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.