Indication and early medicational administration of patients with traumatic brain injury for admission to neurological intensive care unit / 中华创伤杂志

ABSTRACT

Objective:To analyze the indication and status of early use of analgesic, sedative and antiepileptic drugs of patients with traumatic brain injury (TBI) admitted to the neurological intensive care unit (NICU).Methods:A questionnaire covering hospital basic characteristics, prehospital and emergency care, inpatient treatment, neurocritical care and rehabilitation were used to survey NICU of 37 hospitals in 18 municipalities or provinces from the Chinese registry of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) by Web or Email. The indications for admission to the NICU, categories and frequency of early use of analgesic and sedative drugs, and categories, frequency and indications of early use of antiepileptic drugs were analyzed.Results:Glasgow coma scale (GCS)≤8 points in patients with TBI and post-operation of TBI were the main indications for admission in 30 NICU (81.1%) and 24 NICU (64.9%), respectively. When admitting patients with a GCS of 9-12 points or 13-15 points, most NICU gave more considerations to the combined other risk factors. In terms of the early use of analgesics and sedatives, fentanyl was routinely used for analgesia (i.e., use frequency for 70%-100%) in 13 NICU (35.1%), and midazolam and alpha-2 agonists were routinely used for sedation in 24 NICU (64.9%) and 18 NICU (48.6%), respectively. Regarding the early use of antiepileptic drugs, sodium valproate was routinely used in 35 NICU (94.6%). Moreover, seizures within 2 hours after injury, penetrating TBI and cortical contusion were indications for routine application of antiepileptic drugs in 35 NICU (94.6%), 21 NICU (56.8%) and 20 NICU (54.1%), respectively.Conclusions:Severe TBI and post-operation of TBI are the main indications for admission to the NICU, while the combination of other risk factors will be considered when admitting patients with moderate or mild TBI. For TBI patients admitted to NICU, fentanyl, midazolam and sodium valproate are the most commonly used analgesic, sedative, and antiepileptic drugs in the early stage. Seizures within 2 hours after injury, penetrating TBI and cortical contusion are the main indications for antiepileptic drug use.