Staircase strategy, tier-three therapies, and effects on outcome in traumatic brain injured patients: the Triple-T TBI study

PurposeTo evaluate the clinical practice and timing of use of tier-three therapies (TTT) after traumatic brain injury (TBI), and to explore their association with intensive care unit (ICU) mortality and 3 months neurological outcome.MethodsInternational multicenter, retrospective, observational, coh...

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Autores: Picetti, E, Galarza, L, Diez, MA, Badenes, R, Sanz, MAB, Barea-Mendoza, JA, Bórtoli, RG, Bouzat, P, Citerio, G, Godoy, DA, Gritti, P, Magnoni, S, Munari, M, Tellambura, T, van der Jagt, M, Taccone, FS, Robba, C
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p18782
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/18782
Access Level:acceso abierto
Palabra clave:Tier-three therapies
Traumatic brain injury
Intracranial hypertension
Barbiturate coma
Secondary decompressive craniectomy
Therapeutic hypothermia
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spelling Staircase strategy, tier-three therapies, and effects on outcome in traumatic brain injured patients: the Triple-T TBI studyPicetti, EGalarza, LDiez, MABadenes, RSanz, MABBarea-Mendoza, JABórtoli, RGBouzat, PCiterio, GGodoy, DAGritti, PMagnoni, SMunari, MTellambura, Tvan der Jagt, MTaccone, FSRobba, CTier-three therapiesTraumatic brain injuryIntracranial hypertensionBarbiturate comaSecondary decompressive craniectomyTherapeutic hypothermiaPurposeTo evaluate the clinical practice and timing of use of tier-three therapies (TTT) after traumatic brain injury (TBI), and to explore their association with intensive care unit (ICU) mortality and 3 months neurological outcome.MethodsInternational multicenter, retrospective, observational, cohort study performed in 16 ICUs including 408 adult TBI patients requiring at least one of the TTT [i.e. metabolic suppression with barbiturates, secondary decompressive craniectomy (DC), and mild hypothermia] for the control of intracranial hypertension during the ICU stay.ResultsAmong 408 adult TBI patients, secondary DC was the most frequent TTT utilized (n = 297, 72.8%), and was associated with reduced ICU mortality [Odds Ratio, OR 0.34 (95% Confidence Interval, CI 0.14-0.78) p = 0.012] and better neurological outcome (p = 0.047), whereas barbiturates were associated with increased ICU mortality [OR: 3.05 (95% CI 1.43-6.49); p = 0.004) and worse neurological outcome (p = 0.032). Two hundred and twenty-four (55%) patients received interventions in adherence to guidelines, which was associated with a non-significant trend towards better outcomes.ConclusionsThe staircase approach before the use of TTT was not often utilized after severe TBI. Secondary DC was performed more often than other treatments and its use was associated with improved mortality and neurological outcome. The benefits of adherence to guidelines before TTT prescription should be further evaluated.Springer Verlag2025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fisabio.portalinvestigacion.com/publicaciones/18782Intensive Care MedicineISSN: 14321238ISSNe: 03424642reponame:r-FISABIO. Repositorio Institucional de Producción Científicainstname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)Inglésinfo:eu-repo/semantics/openAccessoai:fisabio.fundanetsuite.com:p187822026-06-11T12:45:17Z
dc.title.none.fl_str_mv Staircase strategy, tier-three therapies, and effects on outcome in traumatic brain injured patients: the Triple-T TBI study
title Staircase strategy, tier-three therapies, and effects on outcome in traumatic brain injured patients: the Triple-T TBI study
spellingShingle Staircase strategy, tier-three therapies, and effects on outcome in traumatic brain injured patients: the Triple-T TBI study
Picetti, E
Tier-three therapies
Traumatic brain injury
Intracranial hypertension
Barbiturate coma
Secondary decompressive craniectomy
Therapeutic hypothermia
title_short Staircase strategy, tier-three therapies, and effects on outcome in traumatic brain injured patients: the Triple-T TBI study
title_full Staircase strategy, tier-three therapies, and effects on outcome in traumatic brain injured patients: the Triple-T TBI study
title_fullStr Staircase strategy, tier-three therapies, and effects on outcome in traumatic brain injured patients: the Triple-T TBI study
title_full_unstemmed Staircase strategy, tier-three therapies, and effects on outcome in traumatic brain injured patients: the Triple-T TBI study
title_sort Staircase strategy, tier-three therapies, and effects on outcome in traumatic brain injured patients: the Triple-T TBI study
dc.creator.none.fl_str_mv Picetti, E
Galarza, L
Diez, MA
Badenes, R
Sanz, MAB
Barea-Mendoza, JA
Bórtoli, RG
Bouzat, P
Citerio, G
Godoy, DA
Gritti, P
Magnoni, S
Munari, M
Tellambura, T
van der Jagt, M
Taccone, FS
Robba, C
author Picetti, E
author_facet Picetti, E
Galarza, L
Diez, MA
Badenes, R
Sanz, MAB
Barea-Mendoza, JA
Bórtoli, RG
Bouzat, P
Citerio, G
Godoy, DA
Gritti, P
Magnoni, S
Munari, M
Tellambura, T
van der Jagt, M
Taccone, FS
Robba, C
author_role author
author2 Galarza, L
Diez, MA
Badenes, R
Sanz, MAB
Barea-Mendoza, JA
Bórtoli, RG
Bouzat, P
Citerio, G
Godoy, DA
Gritti, P
Magnoni, S
Munari, M
Tellambura, T
van der Jagt, M
Taccone, FS
Robba, C
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Tier-three therapies
Traumatic brain injury
Intracranial hypertension
Barbiturate coma
Secondary decompressive craniectomy
Therapeutic hypothermia
topic Tier-three therapies
Traumatic brain injury
Intracranial hypertension
Barbiturate coma
Secondary decompressive craniectomy
Therapeutic hypothermia
description PurposeTo evaluate the clinical practice and timing of use of tier-three therapies (TTT) after traumatic brain injury (TBI), and to explore their association with intensive care unit (ICU) mortality and 3 months neurological outcome.MethodsInternational multicenter, retrospective, observational, cohort study performed in 16 ICUs including 408 adult TBI patients requiring at least one of the TTT [i.e. metabolic suppression with barbiturates, secondary decompressive craniectomy (DC), and mild hypothermia] for the control of intracranial hypertension during the ICU stay.ResultsAmong 408 adult TBI patients, secondary DC was the most frequent TTT utilized (n = 297, 72.8%), and was associated with reduced ICU mortality [Odds Ratio, OR 0.34 (95% Confidence Interval, CI 0.14-0.78) p = 0.012] and better neurological outcome (p = 0.047), whereas barbiturates were associated with increased ICU mortality [OR: 3.05 (95% CI 1.43-6.49); p = 0.004) and worse neurological outcome (p = 0.032). Two hundred and twenty-four (55%) patients received interventions in adherence to guidelines, which was associated with a non-significant trend towards better outcomes.ConclusionsThe staircase approach before the use of TTT was not often utilized after severe TBI. Secondary DC was performed more often than other treatments and its use was associated with improved mortality and neurological outcome. The benefits of adherence to guidelines before TTT prescription should be further evaluated.
publishDate 2025
dc.date.none.fl_str_mv 2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fisabio.portalinvestigacion.com/publicaciones/18782
url https://fisabio.portalinvestigacion.com/publicaciones/18782
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Springer Verlag
publisher.none.fl_str_mv Springer Verlag
dc.source.none.fl_str_mv Intensive Care Medicine
ISSN: 14321238
ISSNe: 03424642
reponame:r-FISABIO. Repositorio Institucional de Producción Científica
instname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
instname_str Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
reponame_str r-FISABIO. Repositorio Institucional de Producción Científica
collection r-FISABIO. Repositorio Institucional de Producción Científica
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,811543

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