Key result
TBI sedation follows provider preference over institutional guidelines in ~68% of cases, driving wide practice variation.
Why the study?
Analgo-sedation is important in managing traumatic brain injury in intensive care, but limited evidence guides practice.
Cross-Sectional (n=95)
Yes
There is wide international practice-pattern variation in the sedation management of critically ill TBI patients, largely driven by provider preference rather than institutional guidelines.
High provider-driven variation in TBI sedation persists despite limited guidelines; leaves open whether standardization affects outcomes.
Background: Analgo-sedation plays an important role during intensive care management of traumatic brain injury (TBI) patients, however, limited evidence is available to guide practice. We sought to quantify practice-pattern variation in neurotrauma sedation management, surveying an international sample of providers. Methods: An electronic survey consisting of 56 questions was distributed internationally to neurocritical care providers utilizing the Research Electronic Data Capture platform. Descriptive statistics were used to quantitatively describe and summarize the responses. Results: Ninety-five providers from 37 countries responded. 56.8% were attending physicians with primary medical training most commonly in intensive care medicine (68.4%) and anesthesiology (26.3%). Institutional sedation guidelines for TBI patients were available in 43.2%. Most common sedative agents for induction and maintenance, respectively, were propofol (87.5% and 88.4%), opioids (60.2% and 70.5%), and benzodiazepines (53.4% and 68.4%). Induction and maintenance sedatives, respectively, are mostly chosen according to provider preference (68.2% and 58.9%) rather than institutional guidelines (26.1% and 35.8%). Sedation duration for patients with intracranial hypertension ranged from 24 h to 14 days. Neurological wake-up testing (NWT) was routinely performed in 70.5%. The most common NWT frequency was every 24 h (47.8%), although 20.8% performed NWT at least every 2 h. Richmond Agitation and Sedation Scale targets varied from deep sedation (34.7%) to alert and calm (17.9%). Conclusions: Among critically ill TBI patients, sedation management follows provider preference rather than institutional sedation guidelines. Wide practice-pattern variation exists for the type, duration, and target of sedative management and NWT performance. Future comparative effectiveness research investigating these differences may help optimize sedation strategies to promote recovery.
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Dolmans et al. (2023) conducted a cross-sectional in Traumatic brain injury (n=95). Sedation management practices was evaluated on Practice-pattern variation in neurotrauma sedation management. Sedation management for TBI patients follows provider preference (68.2% for induction) rather than institutional guidelines (26.1%), with wide variation in type, duration, and targets.
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