在创伤性脑损伤后有针对性的温度控制:ESICM/NACCS最佳实践共识建议
Andrea Lavinio1,2, Jonathan P Coles3,4, Chiara Robba5
1Department of Medicine, BOX 1 Addenbrooke's Hospital, University of Cambridge, Long Road, Cambridge, CB2 0QQ, UK. andrea.lavinio1@nhs.net.
Critical care (London, England)
|May 20, 2024
概括
有针对性的温度控制 (TTC) 对于创伤性脑损伤 (TBI) 患者的高质量护理至关重要. 建议持续监测和控制发烧,以防止二次脑损伤.
科学领域:
- 神经科学是一个神经科学.
- 关键护理医学 关键护理医学
- 神经学 神经学
背景情况:
- 创伤性脑损伤 (TBI) 管理需要精确控制内压力 (ICP).
- 发烧和温度失调是TBI患者常见的并发症,可能会恶化二次脑损伤.
- 现有的TBI管理指南需要更新针对性温度控制 (TTC) 的建议.
研究的目的:
- 在严重TBI和恶化的中度TBI患者中制定针对性温度控制 (TTC) 的共识建议.
- 建立基于证据的指导方针,用于重症监护病房的ICP管理.
- 为TTC提供最佳实践提供信息,并确定TBI护理的研究需求.
主要方法:
- 一个经过修改的Delphi过程,涉及18名国际神经重症监护专家.
- 系统的文献审查,为在线匿名调查提供信息.
- 预期的共识值 (强烈共识≥88%,适度共识≥78%) 已被设定.
主要成果:
- 强烈的共识是,TTC对于高质量的TBI护理至关重要.
- 对风险患者的持续温度监测和快速发烧管理的建议.
- 控制的正常热量 (36.0-37.5°C) 在TBI ICP管理协议中被推为治疗选择.
结论:
- 专家的共识支持TTC作为TBI管理的关键组成部分.
- 建议根据二次伤害风险和发烧原因,制定个性化的温度目标.
- 需要进一步的研究来完善TBI中TTC的临床指南.
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