Survey of critical care management of severe traumatic head injury in Israel

Objective: To survey the current monitoring and treatment policies for patients with severe traumatic brain injury (STBI) in Israel, and to compare the management of pediatric and adult intensive care units (ICUs). Design: Questionnaires were sent to the medical directors of all ICUs managing STBI patients. Results: All 21 ICUs responded to the questionnaire. All of the units were within tertiary hospitals. An intracranial pressure (ICP) monitoring device was used in over 75% of the patients in 6 out of 7 (86%) of the pediatric intensive care units (PICUs), compared with 11 out of 14 (79%) of the adults ICUs. Mannitol was used in all of the units for documented elevated ICP. Mild hyperventilation (4-4.6 kPa) was applied in 52% of the units. Mild hypothermia was routinely used in 4 out of 7 (57%) and hypertonic solutions (NaCI 3%) in 3 out of 7 (43%) of the PICUs, compared with only 2 out of 14 (14%) and none (0%) of the adults ICUs respectively. PICUs aimed for a lower ICP (≤15 mm Hg) and cerebral perfusion pressure (≥50 mm Hg) than adult ICUs (≤20 mm Hg and ≥60 mmHg respectively). Barbiturates were used only in patients with refractory intracranial hypertension. Conclusion: This survey reveals a relatively high degree of homogeneity in the treatment of STBI patients in Israel. Most patients are treated in accordance with recently published literature. We attribute this uniformity to the fact that all patients are being treated within tertiary care, university-affiliated centers. PICUs are faster at implementing new modalities of treatment and tend to adopt more aggressive treatment strategies.