title: The Monitoring and Management of Severe Traumatic Brain Injury in the United Kingdom: Is there a Consensus?: A National Survey.
abstract: BACKGROUND
  To survey the current practice of monitoring and management of severe traumatic brain injury (TBI) patients in the critical care units across the United Kingdom.
  
  
  METHODS
  A structured telephone interview was conducted with senior medical or nursing staff of all the adult neurocritical care units. Thirty-one neurocritical care units that managed adult patients with severe TBI were identified from the Risk Adjustment in Neurocritical Care (RAIN) study and the Society of British Neurological Surgeons.
  
  
  RESULTS
  Intracranial pressure (ICP) monitoring was used in all the 31 institutions. Cerebral perfusion pressure was used in 30 of the 31 units and a Cerebral perfusion pressure target of 60 to 70 mm Hg was the most widely used target (25 of 31 units). Transcranial Doppler was used in 12 units (39%); brain tissue oxygen (PbtO(2)) was used in 8 (26%); cerebral microdialysis was used in 4 (13%); jugular bulb oximetry in 1 unit; and near-infrared spectrometry was not used in any unit. Continuous capnometry was used in 28 (91%) units for mechanically ventilated patients. Mannitol was the most commonly used agent for osmotherapy to treat intracranial hypertension.
  
  
  CONCLUSIONS
  We identified that there was no clear consensus and considerable variation in practice in the management of TBI patients in UK neurocritical care units. A protocol-based management has been shown to improve outcome in sepsis patients. Given the magnitude of the problem, we conclude that there is an urgent need for international consensus guidelines for management of TBI patients in critical care units.
authors.affiliation: *Department of Neurocritical Care, Queen's Hospital, Barking Havering and Redbridge Hospitals NHS Trust, Romford, Essex †Department of Anaesthesia, London Chest Hospital, Barts Health NHS Trust, London ‡Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: Dhuleep S
authors.initials: DS
authors.lastname: Wijayatilake
authors.forename: Chiraag
authors.initials: C
authors.lastname: Talati
authors.forename: Selvakumar
authors.initials: S
authors.lastname: Panchatsharam
mesh_terms: D001785:Blood Gas Monitoring, Transcutaneous / Q000706:statistics & numerical data; D001930:Brain Injuries / Q000451:nursing* / Q000503:physiopathology; D032921:Consensus; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data*; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007407:Interviews as Topic; D007427:Intracranial Pressure / Q000502:physiology; D017551:Microdialysis / Q000706:statistics & numerical data; D008991:Monitoring, Physiologic / Q000379:methods* / Q000706:statistics & numerical data*; D010092:Oximetry / Q000706:statistics & numerical data; D006113:United Kingdom