Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High Altitudes
Neurocritical care is an important branch of critical care medicine. The mechanism of critical neurological damage is complex and diverse, and the pathophysiology changes rapidly. Different pathophysiological changes determine different degrees of brain injury. In a special plateau environment, the...
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Editorial Office of Medical Journal of Peking Union Medical College Hospital
2022-01-01
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| Series: | Xiehe Yixue Zazhi |
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| Online Access: | https://xhyxzz.pumch.cn/en/article/doi/10.12290/xhyxzz.2021-0584 |
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| author | PHURBU Droma CHEN Huan CHEN Wenjin DU Wei LIN Guoying PAN Wenjun CHENG Li GUI Xiying CAI Xin CHODRON Tenzin FU Jianlei LI Qianwei TSE Yang JI Lyu TSERING Samdrup DA Wa GUO Juan QIU Cheng WANG Xiaoting CHAO Yangong LIU Dawei CHAI Wenzhao ZHU Shihong |
| author_facet | PHURBU Droma CHEN Huan CHEN Wenjin DU Wei LIN Guoying PAN Wenjun CHENG Li GUI Xiying CAI Xin CHODRON Tenzin FU Jianlei LI Qianwei TSE Yang JI Lyu TSERING Samdrup DA Wa GUO Juan QIU Cheng WANG Xiaoting CHAO Yangong LIU Dawei CHAI Wenzhao ZHU Shihong |
| author_sort | PHURBU Droma |
| collection | DOAJ |
| description | Neurocritical care is an important branch of critical care medicine. The mechanism of critical neurological damage is complex and diverse, and the pathophysiology changes rapidly. Different pathophysiological changes determine different degrees of brain injury. In a special plateau environment, the incidence of critical neurological disease is higher, the age of onset is younger, the disease progress is faster, and the degree of damage is more severe. In order to standardize the diagnosis and treatment, enhance monitoring and management, provide timely and precise treatment, prevent irreversible brain injury, and improve the prognosis of patients with critical neurological illness at high altitudes, the Research Group of Calm Treatment of China, Research Group of Critical Care Ultrasound of China, and the Quality Control Center of Critical Care Medicine in Tibet formulated the Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High Altitudes on the basis of full discussion and communication of relevant critical medical experts and neurosurgery experts according to domestic and foreign literature and years of experience in clinical application and promotion. The main contents of the consensus are as follows.(1) According to the pathophysiological mechanism of neurological involvement in critical illness, scenarios of neurocritical care at high altitudes can be divided into cerebral hemorrhage at high altitudes, severe traumatic brain injuries, ischemic stroke, cerebral edema at high altitudes, and septic encephalopathy (8.4 points).(2) It is recommended to use cerebral blood flow, brain function monitoring and cerebral oxygen saturation as a 'triad' monitoring core in management of neurocritical care at high altitude, to as well as cerebrospinal fluid dynamics monitoring and brain structure surveillance (9.0 points).(3) It is recommended to grade patients quickly, and the '5-avoids' approach based on 'brain protection' theory were adhered to avoid fever, seizures, anxiety, agitation or pain, shivering, stimulation and nociception, according to different levels. Especially in the 'super critical' stage, with the protection of '446'targets, choose the window for analgesia and sedation (8.4 points).(4) It is recommended to monitor systemic and cerebral hemodynamic continuously and dynamically in order to improve systemic perfusion and optimize cerebral perfusion simultaneously (8.4 points).(5) It is recommended to choose the method of direct measurement of intracranial pressure by intraventricular catheter or optic nerve sheath diameter under ultrasound to estimate intracranial pressure, and choose the appropriate target mean arterial pressure to ensure optimal brain perfusion (8.8 points).(6) It is recommended to use transcranial Doppler ultrasound to evaluate the blood flow velocity and blood flow waveform of the bilateral cerebral arteries. It is recommended to target the blood flow velocity of M1 at 40 cm/s in the 'super critical' period (8.2 points).(7) In the 'super critical' period, we recommend to routinely monitor BIS and maintain the BIS value around 40 as the goal to guide the depth of sedation; those with conditions can be monitored by quantitative electroencephalography to assist determining whether there are non-convulsive seizures, and perform diagnostic evaluation of the prognosis (8.6 points).(8) It is recommended to monitor brain oxygen levels routinely, starting early in the ICU admission of patients with critical neurological conditions at high altitudes, which can assist in the assessment of brain damage (8.6 points).(9) It is recommended to evaluate the cerebral blood flow self-regulation ability routinely to achieve the optimal cerebral perfusion pressure in time and timely adjust the intensity and scheme of treatment (8.2 points).(10) It is recommended to emphasize the importance of target arterial partial pressure of carbon dioxide in the artery in critical illness and neurocritical care at high altitudes (8.0 points).(11) It is recommended to devote attention to the importance of targeted temperature management in in critical illness and neurocritical care at high altitudes (8.6 points).(12) It is recommended that multidisciplinary consultation and multi-professional cooperation could improve the management in critical neurological illness at high altitudes (8.8 points).(13) It is recommended that the constitution of improvement in brain structure imaging, pressure normalization of cerebrospinal fluid and restoration of cerebral blood autoregulation could be as the de-escalation triad (8.0 points).(14) It is recommended to be cautious of paroxysmal sympathetic hyperreactivity patients in neurocritical and critical illness at high altitude (8.0 points).(15) It is recommended to be cautious about the management of agitation (delirium) and cognitive function of patients in TBI at high altitudes(8.0 points).(16) It is recommended to assess the itinerary of the rehabilitation in a timely manner for critically sick patients at high altitudes (8.2 points).(17) It is recommended to be cautious of post-traumatic hydrocephalus and related neuroendocrine abnormalities in patients with critical neurological illness at high altitudes (7.6 points). |
| first_indexed | 2024-04-11T18:15:39Z |
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| institution | Directory Open Access Journal |
| issn | 1674-9081 |
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| last_indexed | 2024-04-11T18:15:39Z |
| publishDate | 2022-01-01 |
| publisher | Editorial Office of Medical Journal of Peking Union Medical College Hospital |
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| series | Xiehe Yixue Zazhi |
| spelling | doaj.art-bec012f0c50b4f269ecbc1f547b60d6f2022-12-22T04:09:57ZzhoEditorial Office of Medical Journal of Peking Union Medical College HospitalXiehe Yixue Zazhi1674-90812022-01-01131243810.12290/xhyxzz.2021-0584Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High AltitudesPHURBU Droma0CHEN Huan1CHEN Wenjin2DU Wei3LIN Guoying4PAN Wenjun5CHENG Li6GUI Xiying7CAI Xin8CHODRON Tenzin9FU Jianlei10LI Qianwei11TSE Yang12JI Lyu13TSERING Samdrup14DA Wa15GUO Juan16QIU Cheng17WANG XiaotingCHAO Yangong18LIU Dawei19CHAI Wenzhao20ZHU Shihong21Department of Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa 850000, ChinaDepartment of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaDepartment of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, ChinaDepartment of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaDepartment of Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa 850000, ChinaDepartment of Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa 850000, ChinaDepartment of Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa 850000, ChinaDepartment of Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa 850000, ChinaDepartment of Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa 850000, ChinaDepartment of Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa 850000, ChinaDepartment of Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa 850000, ChinaDepartment of Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa 850000, ChinaDepartment of Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa 850000, ChinaDepartment of Critical Care Medicine, Shigatse People's Hospital, Shigatse, Tibet 857007, ChinaDepartment of Critical Care Medicine, Tibetan Hospital of Tibet Autonomous Region, Lhasa 850002, ChinaDepartment of Critical Care Medicine, Lhasa People's Hospital, Lhasa 850013, ChinaDepartment of Critical Care Medicine, Nyingchi People's Hospital, Nyingchi, Tibet 860000, ChinaDepartment of Critical Care Medicine, Naqu People's Hospital, Naqu, Tibet 852000, ChinaDepartment of Critical Care Medicine, the First Hospital of Tsinghua University, Beijing 100016, ChinaDepartment of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaDepartment of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaDepartment of Critical Care Medicine, the Seventh Medical Center of PLA General Hospital, Beijing 100010, ChinaNeurocritical care is an important branch of critical care medicine. The mechanism of critical neurological damage is complex and diverse, and the pathophysiology changes rapidly. Different pathophysiological changes determine different degrees of brain injury. In a special plateau environment, the incidence of critical neurological disease is higher, the age of onset is younger, the disease progress is faster, and the degree of damage is more severe. In order to standardize the diagnosis and treatment, enhance monitoring and management, provide timely and precise treatment, prevent irreversible brain injury, and improve the prognosis of patients with critical neurological illness at high altitudes, the Research Group of Calm Treatment of China, Research Group of Critical Care Ultrasound of China, and the Quality Control Center of Critical Care Medicine in Tibet formulated the Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High Altitudes on the basis of full discussion and communication of relevant critical medical experts and neurosurgery experts according to domestic and foreign literature and years of experience in clinical application and promotion. The main contents of the consensus are as follows.(1) According to the pathophysiological mechanism of neurological involvement in critical illness, scenarios of neurocritical care at high altitudes can be divided into cerebral hemorrhage at high altitudes, severe traumatic brain injuries, ischemic stroke, cerebral edema at high altitudes, and septic encephalopathy (8.4 points).(2) It is recommended to use cerebral blood flow, brain function monitoring and cerebral oxygen saturation as a 'triad' monitoring core in management of neurocritical care at high altitude, to as well as cerebrospinal fluid dynamics monitoring and brain structure surveillance (9.0 points).(3) It is recommended to grade patients quickly, and the '5-avoids' approach based on 'brain protection' theory were adhered to avoid fever, seizures, anxiety, agitation or pain, shivering, stimulation and nociception, according to different levels. Especially in the 'super critical' stage, with the protection of '446'targets, choose the window for analgesia and sedation (8.4 points).(4) It is recommended to monitor systemic and cerebral hemodynamic continuously and dynamically in order to improve systemic perfusion and optimize cerebral perfusion simultaneously (8.4 points).(5) It is recommended to choose the method of direct measurement of intracranial pressure by intraventricular catheter or optic nerve sheath diameter under ultrasound to estimate intracranial pressure, and choose the appropriate target mean arterial pressure to ensure optimal brain perfusion (8.8 points).(6) It is recommended to use transcranial Doppler ultrasound to evaluate the blood flow velocity and blood flow waveform of the bilateral cerebral arteries. It is recommended to target the blood flow velocity of M1 at 40 cm/s in the 'super critical' period (8.2 points).(7) In the 'super critical' period, we recommend to routinely monitor BIS and maintain the BIS value around 40 as the goal to guide the depth of sedation; those with conditions can be monitored by quantitative electroencephalography to assist determining whether there are non-convulsive seizures, and perform diagnostic evaluation of the prognosis (8.6 points).(8) It is recommended to monitor brain oxygen levels routinely, starting early in the ICU admission of patients with critical neurological conditions at high altitudes, which can assist in the assessment of brain damage (8.6 points).(9) It is recommended to evaluate the cerebral blood flow self-regulation ability routinely to achieve the optimal cerebral perfusion pressure in time and timely adjust the intensity and scheme of treatment (8.2 points).(10) It is recommended to emphasize the importance of target arterial partial pressure of carbon dioxide in the artery in critical illness and neurocritical care at high altitudes (8.0 points).(11) It is recommended to devote attention to the importance of targeted temperature management in in critical illness and neurocritical care at high altitudes (8.6 points).(12) It is recommended that multidisciplinary consultation and multi-professional cooperation could improve the management in critical neurological illness at high altitudes (8.8 points).(13) It is recommended that the constitution of improvement in brain structure imaging, pressure normalization of cerebrospinal fluid and restoration of cerebral blood autoregulation could be as the de-escalation triad (8.0 points).(14) It is recommended to be cautious of paroxysmal sympathetic hyperreactivity patients in neurocritical and critical illness at high altitude (8.0 points).(15) It is recommended to be cautious about the management of agitation (delirium) and cognitive function of patients in TBI at high altitudes(8.0 points).(16) It is recommended to assess the itinerary of the rehabilitation in a timely manner for critically sick patients at high altitudes (8.2 points).(17) It is recommended to be cautious of post-traumatic hydrocephalus and related neuroendocrine abnormalities in patients with critical neurological illness at high altitudes (7.6 points).https://xhyxzz.pumch.cn/en/article/doi/10.12290/xhyxzz.2021-0584high altitudescritical care medicineneurocriticalmonitoring and management |
| spellingShingle | PHURBU Droma CHEN Huan CHEN Wenjin DU Wei LIN Guoying PAN Wenjun CHENG Li GUI Xiying CAI Xin CHODRON Tenzin FU Jianlei LI Qianwei TSE Yang JI Lyu TSERING Samdrup DA Wa GUO Juan QIU Cheng WANG Xiaoting CHAO Yangong LIU Dawei CHAI Wenzhao ZHU Shihong Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High Altitudes Xiehe Yixue Zazhi high altitudes critical care medicine neurocritical monitoring and management |
| title | Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High Altitudes |
| title_full | Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High Altitudes |
| title_fullStr | Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High Altitudes |
| title_full_unstemmed | Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High Altitudes |
| title_short | Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High Altitudes |
| title_sort | expert consensus on monitoring and management of patients with critical neurological illness at high altitudes |
| topic | high altitudes critical care medicine neurocritical monitoring and management |
| url | https://xhyxzz.pumch.cn/en/article/doi/10.12290/xhyxzz.2021-0584 |
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