Carolina Iaquaniello, Fabio Gallo, Raphael Cinotti, Giuseppe Citerio, Fabio S Taccone, Paolo Pelosi, Rafael Badenes, Chiara Robba
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Five patients (0.3%) received all three TTT. TTT patients were younger (<i>P</i> < 0.0001), less likely to have a preinjury history of hypertension (<i>P</i> = 0.0008), and less frequently anisocoric within 24 h from ICU admission (<i>P</i> < 0.0001) than those with no tier three therapy. TTT were used less frequently in high-income countries than in upper income and lower middle-income countries (no TTT in 78% of patients in high-income countries, in 60.6% of patients in upper middle-income countries, and in 56.6% of patients in lower middle-income countries; <i>P</i> < 0.0001). TTT were more frequent in patients with traumatic brain injury (TBI) compared with other types of ABI and in patients with invasive intracranial pressure (ICP) monitoring (<i>P</i> < 0.0001). TTT use was associated with a higher incidence of ventilator-associated pneumonia (<i>P</i> < 0.0001), need for tracheostomy (<i>P</i> = 0.0194), and prolonged ICU length of stay (LOS; <i>P</i> < 0.0001) but not with increased ICU or hospital mortality (<i>P</i> = 0.999).</p><p><strong>Conclusion: </strong>Patients with ABI are frequently managed using at least one TTT. Their use varies according to a country's economic resources, the type of ABI, and ICP monitoring and is associated with a higher risk of complications but not with ICU or hospital mortality.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"3 1","pages":"e0043"},"PeriodicalIF":0.0000,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798370/pdf/","citationCount":"0","resultStr":"{\"title\":\"The use of tier three therapies in acute brain injured patients: Insight from the Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes observational study.\",\"authors\":\"Carolina Iaquaniello, Fabio Gallo, Raphael Cinotti, Giuseppe Citerio, Fabio S Taccone, Paolo Pelosi, Rafael Badenes, Chiara Robba\",\"doi\":\"10.1097/EA9.0000000000000043\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In patients with acute brain injury (ABI) and refractory intracranial hypertension, the so-called 'tier three therapies' (TTT) (hypothermia, metabolic suppression with barbiturates, and decompressive craniectomy) may be used.</p><p><strong>Objective: </strong>We aimed to describe the incidence of use of TTT, and to assess their effect on outcome.</p><p><strong>Design: </strong>A secondary analysis of the ENIO observational study.</p><p><strong>Setting: </strong>Seventy-three intensive care units (ICUs) in 18 countries worldwide between June 2018 and November 2020.</p><p><strong>Patients: </strong>One thousand five hundred and twelve adult patients admitted to an intensive care unit (ICU) with ABI were included and categorised according to use or not of one or more TTT.</p><p><strong>Results: </strong>Three hundred and ninety-six patients (26.2%) received at least one TTT during the ICU stay. Five patients (0.3%) received all three TTT. TTT patients were younger (<i>P</i> < 0.0001), less likely to have a preinjury history of hypertension (<i>P</i> = 0.0008), and less frequently anisocoric within 24 h from ICU admission (<i>P</i> < 0.0001) than those with no tier three therapy. TTT were used less frequently in high-income countries than in upper income and lower middle-income countries (no TTT in 78% of patients in high-income countries, in 60.6% of patients in upper middle-income countries, and in 56.6% of patients in lower middle-income countries; <i>P</i> < 0.0001). TTT were more frequent in patients with traumatic brain injury (TBI) compared with other types of ABI and in patients with invasive intracranial pressure (ICP) monitoring (<i>P</i> < 0.0001). TTT use was associated with a higher incidence of ventilator-associated pneumonia (<i>P</i> < 0.0001), need for tracheostomy (<i>P</i> = 0.0194), and prolonged ICU length of stay (LOS; <i>P</i> < 0.0001) but not with increased ICU or hospital mortality (<i>P</i> = 0.999).</p><p><strong>Conclusion: </strong>Patients with ABI are frequently managed using at least one TTT. Their use varies according to a country's economic resources, the type of ABI, and ICP monitoring and is associated with a higher risk of complications but not with ICU or hospital mortality.</p>\",\"PeriodicalId\":520410,\"journal\":{\"name\":\"European journal of anaesthesiology and intensive care\",\"volume\":\"3 1\",\"pages\":\"e0043\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-01-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798370/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European journal of anaesthesiology and intensive care\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/EA9.0000000000000043\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/2/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European journal of anaesthesiology and intensive care","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/EA9.0000000000000043","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/2/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:对于急性脑损伤(ABI)和难治性颅内高压患者,可能会使用所谓的“三级治疗”(TTT)(低温、巴比妥类药物抑制代谢和减压颅骨切除术)。目的:我们旨在描述TTT使用的发生率,并评估其对预后的影响。设计:对ENIO观察性研究进行二次分析。环境:2018年6月至2020年11月期间,全球18个国家的73个重症监护病房(icu)。患者:纳入1212名患有ABI的重症监护病房(ICU)成年患者,并根据是否使用一种或多种TTT进行分类。结果:396例患者(26.2%)在ICU住院期间接受了至少一次TTT治疗。5名患者(0.3%)接受了全部三种TTT治疗。TTT患者年龄较轻(P = 0.0008),入院后24 h内异角化发生率较低(P P P P P = 0.0194),住院时间较长(LOS;p = 0.999)。结论:ABI患者通常使用至少一种TTT治疗。它们的使用根据一个国家的经济资源、ABI类型和ICP监测而有所不同,并与较高的并发症风险相关,但与ICU或医院死亡率无关。
The use of tier three therapies in acute brain injured patients: Insight from the Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes observational study.
Background: In patients with acute brain injury (ABI) and refractory intracranial hypertension, the so-called 'tier three therapies' (TTT) (hypothermia, metabolic suppression with barbiturates, and decompressive craniectomy) may be used.
Objective: We aimed to describe the incidence of use of TTT, and to assess their effect on outcome.
Design: A secondary analysis of the ENIO observational study.
Setting: Seventy-three intensive care units (ICUs) in 18 countries worldwide between June 2018 and November 2020.
Patients: One thousand five hundred and twelve adult patients admitted to an intensive care unit (ICU) with ABI were included and categorised according to use or not of one or more TTT.
Results: Three hundred and ninety-six patients (26.2%) received at least one TTT during the ICU stay. Five patients (0.3%) received all three TTT. TTT patients were younger (P < 0.0001), less likely to have a preinjury history of hypertension (P = 0.0008), and less frequently anisocoric within 24 h from ICU admission (P < 0.0001) than those with no tier three therapy. TTT were used less frequently in high-income countries than in upper income and lower middle-income countries (no TTT in 78% of patients in high-income countries, in 60.6% of patients in upper middle-income countries, and in 56.6% of patients in lower middle-income countries; P < 0.0001). TTT were more frequent in patients with traumatic brain injury (TBI) compared with other types of ABI and in patients with invasive intracranial pressure (ICP) monitoring (P < 0.0001). TTT use was associated with a higher incidence of ventilator-associated pneumonia (P < 0.0001), need for tracheostomy (P = 0.0194), and prolonged ICU length of stay (LOS; P < 0.0001) but not with increased ICU or hospital mortality (P = 0.999).
Conclusion: Patients with ABI are frequently managed using at least one TTT. Their use varies according to a country's economic resources, the type of ABI, and ICP monitoring and is associated with a higher risk of complications but not with ICU or hospital mortality.