Intracranial multimodal monitoring in neurocritical care (Neurocore-iMMM): an open, decentralized consensus.
Details
Serval ID
serval:BIB_6934F0370F5F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Intracranial multimodal monitoring in neurocritical care (Neurocore-iMMM): an open, decentralized consensus.
Journal
Critical care
Working group(s)
Neurocore-iMMM Research Group
Contributor(s)
Al Barajraji M., Alb I., Amorim E., Appavu B., Balanca B., Barrit S., Ben-Hamouda N., Bernard F., Carrabba G.G., Chabanne R., Citerio G., Hadwe S.E., Foreman B., Gilmore E., Gonzalez M.I., Guenego A., Hajdu S.D., Helbok R., Hutchinson PJA, Jurjans K., Kirschen M.P., Lagares A., Lazaridis C., Levine J.M., Luoto T.M., Marklund N., Massager N., Mazeraud A., Messerer M., Montellano F., Ngwenya L.B., Niset A., Park S., Pinggera D., Rass V., Remacle T.Y., Robba C., Rodriguez S.A., Shutter L., Taccone F.S., Terpolilli N.A., Torcida Sedano N., Tsitsopoulos P.P., Van Essen T.A., Vlahovic D., Waziri A., Willms J.F., Younsi A.
ISSN
1466-609X (Electronic)
ISSN-L
1364-8535
Publication state
Published
Issued date
20/12/2024
Peer-reviewed
Oui
Volume
28
Number
1
Pages
427
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: epublish
Publication Status: epublish
Abstract
Intracranial multimodal monitoring (iMMM) is increasingly used in neurocritical care, but a lack of standardization hinders its evidence-based development. Here, we devised core outcome sets (COS) and reporting guidelines to harmonize iMMM practices and research.
An open, decentralized, three-round Delphi consensus study involved experts between December 2023 and June 2024. Items-spanning three domains: (i) patient characteristics, (ii) practices, and (iii) outcomes-with ≥ 75% agreement were classified as strong agreement, while those with 50-75% were reconsidered in subsequent rounds, requiring ≥ 66% for moderate agreement.
An international, multidisciplinary panel comprised 58 neurocritical physicians and researchers with low attrition (12%). They were predominantly from Western regions (96%), actively involved in iMMM (82%), at least weekly (72.4%), with more than 10 years of specific experience (57%). Of the 127 items assessed for inclusion in COS and reporting guidelines, 45 (35.4%) reached strong and 8 (6.3%) moderate agreement. Main strong agreement items were: (i) demographics: age (98%) and sex/gender (90%); comorbidities: coagulation/platelet disorders (95%); initial scoring: Glasgow Coma Scale (97%) and pathology-specific scores (90%); active treatments: antithrombotics (95%) (ii) clinical practice: iMMM implantation indications (98%) and iMMM-guided interventions (91%); surgical practice: targeting strategies (97%) and concomitant external ventricular drainage (97%); technical details: recording modalities (98%); (iii) monitoring parameters: duration (97%) and triggered interventions (95%); standardized outcome reporting (93%); surgical complications (e.g., postoperative intracranial hemorrhages, CNS infections, and probe misplacement, all > 90%) and adverse events (accidental dislodgement, probe breakage, and technical malfunctions, all > 90%).
This consensus establishes foundational COS and reporting guidelines for iMMM in neurocritical care. These harmonization tools can enhance research quality, comparability, and reproducibility, facilitating evidence-based practices for this emerging technology. However, challenges remain in developing purpose-specific guidelines and adapting them to diverse clinical and research settings.
An open, decentralized, three-round Delphi consensus study involved experts between December 2023 and June 2024. Items-spanning three domains: (i) patient characteristics, (ii) practices, and (iii) outcomes-with ≥ 75% agreement were classified as strong agreement, while those with 50-75% were reconsidered in subsequent rounds, requiring ≥ 66% for moderate agreement.
An international, multidisciplinary panel comprised 58 neurocritical physicians and researchers with low attrition (12%). They were predominantly from Western regions (96%), actively involved in iMMM (82%), at least weekly (72.4%), with more than 10 years of specific experience (57%). Of the 127 items assessed for inclusion in COS and reporting guidelines, 45 (35.4%) reached strong and 8 (6.3%) moderate agreement. Main strong agreement items were: (i) demographics: age (98%) and sex/gender (90%); comorbidities: coagulation/platelet disorders (95%); initial scoring: Glasgow Coma Scale (97%) and pathology-specific scores (90%); active treatments: antithrombotics (95%) (ii) clinical practice: iMMM implantation indications (98%) and iMMM-guided interventions (91%); surgical practice: targeting strategies (97%) and concomitant external ventricular drainage (97%); technical details: recording modalities (98%); (iii) monitoring parameters: duration (97%) and triggered interventions (95%); standardized outcome reporting (93%); surgical complications (e.g., postoperative intracranial hemorrhages, CNS infections, and probe misplacement, all > 90%) and adverse events (accidental dislodgement, probe breakage, and technical malfunctions, all > 90%).
This consensus establishes foundational COS and reporting guidelines for iMMM in neurocritical care. These harmonization tools can enhance research quality, comparability, and reproducibility, facilitating evidence-based practices for this emerging technology. However, challenges remain in developing purpose-specific guidelines and adapting them to diverse clinical and research settings.
Keywords
Humans, Critical Care/methods, Critical Care/standards, Consensus, Delphi Technique, Monitoring, Physiologic/methods, Monitoring, Physiologic/standards, Male, Female, Brain tissue oxygenation, ICP, Intracranial multimodal monitoring, Intracranial pressure, MNM, Microdialysis, Multimodal neuromonitoring, Neurocritical care, Pbto2, iMMM
Pubmed
Open Access
Yes
Create date
21/12/2024 23:08
Last modification date
22/12/2024 7:09
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