Survey of critical care management of severe traumatic head injury in Israel.
OBJECTIVE
To survey the current monitoring and treatment policies for patients with severe traumatic brain injury (STBI) in Israel, and to compare the management of pediatric and adult intensive care units (ICUs).


METHODS
Questionnaires were sent to the medical directors of all ICUs managing STBI patients.


RESULTS
All 21 ICUs responded to the questionnaire. All of the units were within tertiary hospitals. An intracranial pressure (ICP) monitoring device was used in over 75% of the patients in 6 out of7 (86%) of the pediatric intensive care units (PICUs), compared with 11 out of 14 (79%) of the adults ICUs. Mannitol was used in all of the units for documented elevated ICP. Mild hyperventilation (4-4.6 kPa) was applied in 52% of the units. Mild hypothermia was routinely used in 4 out of 7 (57%) and hypertonic solutions (NaCI 3%) in 3 out of 7 (43%) of the PICUs, compared with only 2 out of 14 (14%) and none (0%) of the adults ICUs respectively. PICUs aimed for a lower ICP (< or =15 mm Hg) and cerebral perfusion pressure (> or =50 mm Hg) than adult ICUs (< or =20 mm Hg and > or =60 mmHg respectively). Barbiturates were used only in patients with refractory intracranial hypertension.


CONCLUSIONS
This survey reveals a relatively high degree of homogeneity in the treatment of STBI patients in Israel. Most patients are treated in accordance with recently published literature. We attribute this uniformity to the fact that all patients are being treated within tertiary care, university-affiliated centers. PICUs are faster at implementing new modalities of treatment and tend to adopt more aggressive treatment strategies.
Pediatric Critical Care Unit, Dana Children's Hospital, Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 64239, Israel. alikk@netvision.net.il
Alik
A
Kornecki
Shlomo
S
Constantini
Liana Beni
LB
Adani
Hagit
H
Nagar
Michael
M
Halberthal
Yakov
Y
Sivan
D000293:Adolescent; D001930:Brain Injuries / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data*; D015600:Glasgow Coma Scale; D019538:Health Care Surveys; D006801:Humans; D006985:Hyperventilation; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007407:Interviews as Topic; D007427:Intracranial Pressure / Q000502:physiology; D007557:Israel; D008991:Monitoring, Physiologic; D010043:Outcome and Process Assessment, Health Care; D011795:Surveys and Questionnaires