Neurocritical Care

, Volume 21, Supplement 2, pp 1–26 | Cite as

Consensus Summary Statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care

A statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine
  • Peter Le Roux
  • David K. Menon
  • Giuseppe Citerio
  • Paul Vespa
  • Mary Kay Bader
  • Gretchen M. Brophy
  • Michael N. Diringer
  • Nino Stocchetti
  • Walter Videtta
  • Rocco Armonda
  • Neeraj Badjatia
  • Julian Böesel
  • Randall Chesnut
  • Sherry Chou
  • Jan Claassen
  • Marek Czosnyka
  • Michael De Georgia
  • Anthony Figaji
  • Jennifer Fugate
  • Raimund Helbok
  • David Horowitz
  • Peter Hutchinson
  • Monisha Kumar
  • Molly McNett
  • Chad Miller
  • Andrew Naidech
  • Mauro Oddo
  • DaiWai Olson
  • Kristine O’Phelan
  • J. Javier Provencio
  • Corinna Puppo
  • Richard Riker
  • Claudia Robertson
  • Michael Schmidt
  • Fabio Taccone
Review Article
First Online:

Abstract

Neurocritical care depends, in part, on careful patient monitoring but as yet there are little data on what processes are the most important to monitor, how these should be monitored, and whether monitoring these processes is cost-effective and impacts outcome. At the same time, bioinformatics is a rapidly emerging field in critical care but as yet there is little agreement or standardization on what information is important and how it should be displayed and analyzed. The Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine, and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to begin to address these needs. International experts from neurosurgery, neurocritical care, neurology, critical care, neuroanesthesiology, nursing, pharmacy, and informatics were recruited on the basis of their research, publication record, and expertise. They undertook a systematic literature review to develop recommendations about specific topics on physiologic processes important to the care of patients with disorders that require neurocritical care. This review does not make recommendations about treatment, imaging, and intraoperative monitoring. A multidisciplinary jury, selected for their expertise in clinical investigation and development of practice guidelines, guided this process. The GRADE system was used to develop recommendations based on literature review, discussion, integrating the literature with the participants’ collective experience, and critical review by an impartial jury. Emphasis was placed on the principle that recommendations should be based on both data quality and on trade-offs and translation into clinical practice. Strong consideration was given to providing pragmatic guidance and recommendations for bedside neuromonitoring, even in the absence of high quality data.

Keywords

Consensus development conference Grading of Recommendations Assessment Development and Evaluation (GRADE) Brain metabolism Brain oxygen Clinical trials Intracranial pressure Microdialysis Multimodal monitoring Neuromonitoring Traumatic brain injury Brain physiology Bioinformatics Biomarkers Neurocritical care Clinical guidelines 
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Notes

Acknowledgments

We would like to thank Janel Fick and Joanne Taie for their administrative support.

Conflicts of interest

Each author and each member of the jury reported any potential conflicts of interest (COI). The author and NCS Guideline Committee Chairs determined any required resolutions according to NCS COI process and resolution guidelines before appointment to the writing committee. The following methods were used to resolve any potential COI: (1) Perform peer review for evidence-based content, (2) provide faculty with alternate topic, (3) provide alternate faculty for specific topics, (4) limit content to evidence with no recommendations, (5) perform review of all materials associated with the activity by planning committee, (6) abstain from discussions related to the conflict, (7) abstain from voting related to the conflict, (8) request reassignment to a committee that will not result in a conflict. NCS Guidelines state: “The chair or co-chairs cannot have any financial or other important conflicts of interest related to the guideline topic.” PLR proposed the subject and initiated the project and therefore was appointed chair by the NCS. To be compliant with NCS Guidelines he did not vote on any of the recommendations that followed jury deliberations because of potential COI associated with industry relationships.

Peter Le Roux receives research funding from Integra Lifesciences, Neurologica, the Dana Foundation, and the National Institutes of Health (NIH); is a consultant for Integra Lifesciences, Codman, Synthes, and Neurologica; and is a member of the scientific advisory board of Cerebrotech, Brainsgate, Orsan, and Edge Therapeutics.

Mary Kay Bader receives honoraria from Bard, The Medicines Company, and Neuroptics and has Stock options in Neuroptics.

Neeraj Badjatia receives consulting fees from Bard and Medivance and is a Scientific Advisor to Cumberland Pharmaceuticals.

Julian Boesel receives honoraria from Covidien, Sedana Medical, and Orion Pharma.

Gretchen Brophy receives research funding from the NIH and the Department of Defense (DoD); is on the scientific advisory board of Edge Therapeutics; has acted as a consultant for CSL Behring; and has received honoraria from UCB Pharma.

Sherry Chou receives research funding from the NIH and Novartis.

Giuseppe Citerio receives speaker honoraria from Codman and has received research funding from Italian government agencies (AIFA, Ministero Salute, Regione Lombardia).

Marek Czosnyka is a consultant for Cambridge Enterprise Ltd and serves on the Speakers Bureau for Bard Medical.

Michael Diringer receives research funding from the NIH and the AHA and is a consultant for Cephalogics LLC.

Monisha Kumar receives research funding from Haemonetics.

Molly McNett is a consultant for Bard Medivance and a scientific advisor for Cumberland Pharmaceuticals.

David Menon has acted as a consultant or a member of Steering or Data Management Committees for Solvay Ltd, GlaxoSmithKline Ltd, Brainscope Ltd, Ornim Medical, Shire Medical, and Neurovive Ltd.

J. Javier Provencio receives research funding from the NIH, Bard Medivance, and Advanced Circulatory Systems, and is on the scientific advisory board of Edge Therapeutics and Minnetronix.

Nino Stocchetti is a consultant for Orsan.

Paul Vespa receives grant funding from the NIH, DOD; is a consultant for Edge Therapeutics; and has Stock Options with Intouch Health.

Walter Videtta receives NIH funding.

Rocco Armondo, Randall Chesnut, Jan Classen, Michael De Georgia, Anthony Figaji, Jennifer Fugate, Raimund Helbok, David Horowitz, Peter Hutchinson, Chad Miller, Andrew Naidech, Mauro Oddo, DaiWai Olson, Kristine O’Phelan, Corinna Puppo, Richard Riker, Claudia Robertson, Michael Schmidt, Fabio Taccone have declared no conflicts of interest.

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© All content, design, text, and other materials are copyrighted by the Neurocritical Care Society (NCS). All rights reserved. Endorsed by the Society of Critical Care Medicine and Latin American Brain Injury Consortium. This article is endorsed by the Eu 2014

Authors and Affiliations

  • Peter Le Roux
    • 1
  • David K. Menon
    • 2
  • Giuseppe Citerio
    • 3
  • Paul Vespa
    • 4
  • Mary Kay Bader
    • 5
  • Gretchen M. Brophy
    • 6
  • Michael N. Diringer
    • 7
  • Nino Stocchetti
    • 8
  • Walter Videtta
    • 9
  • Rocco Armonda
    • 10
  • Neeraj Badjatia
    • 11
  • Julian Böesel
    • 12
  • Randall Chesnut
    • 13
  • Sherry Chou
    • 14
  • Jan Claassen
    • 15
  • Marek Czosnyka
    • 16
  • Michael De Georgia
    • 17
  • Anthony Figaji
    • 18
  • Jennifer Fugate
    • 19
  • Raimund Helbok
    • 20
  • David Horowitz
    • 21
  • Peter Hutchinson
    • 22
  • Monisha Kumar
    • 23
  • Molly McNett
    • 24
  • Chad Miller
    • 25
  • Andrew Naidech
    • 26
  • Mauro Oddo
    • 27
  • DaiWai Olson
    • 28
  • Kristine O’Phelan
    • 29
  • J. Javier Provencio
    • 30
  • Corinna Puppo
    • 31
  • Richard Riker
    • 32
  • Claudia Robertson
    • 33
  • Michael Schmidt
    • 34
  • Fabio Taccone
    • 35
  1. 1.Brain and Spine Center, Suite 370, Medical Science BuildingLankenau Medical CenterWynnewoodUSA
  2. 2.Neurosciences Critical Care Unit, Division of AnaesthesiaUniversity of Cambridge ConsultantCambridgeUK
  3. 3.NeuroIntensive Care Unit, Department of Anesthesia and Critical CareOspedale San GerardoMonzaItaly
  4. 4.David Geffen School of Medicine at UCLALos AngelesUSA
  5. 5.Neuro/Critical Care CNSMission HospitalMission ViejoUSA
  6. 6.Virginia Commonwealth UniversityRichmondUSA
  7. 7.Neurocritical Care Section, Department of NeurologyWashington UniversitySt LouisUSA
  8. 8.Department of Physiopathology and TransplantMilan University, Neuro ICU, Fondazione IRCCS Cà Granda Ospedale Maggiore PoliclinicoMilanItaly
  9. 9.ICU Neurocritical CareHospital Nacional ‘Prof. a. Posadas’, El PalomarPcia de Buenos AiresArgentina
  10. 10.Department of NeurosurgeryMedStar Georgetown University Hospital, Medstar HealthWashingtonUSA
  11. 11.Department of NeurologyUniversity of Maryland Medical CenterBaltimoreUSA
  12. 12.Department of NeurologyRuprecht-Karls University, Hospital HeidelbergHeidelbergGermany
  13. 13.Harborview Medical CenterUniversity of WashingtonSeattleUSA
  14. 14.Department of NeurologyBrigham and Women’s HospitalBostonUSA
  15. 15.Neurological Intensive Care UnitColumbia University College of Physicians and SurgeonsNew YorkUSA
  16. 16.Department of NeurosurgeryUniversity of Cambridge, Addenbrooke’s HospitalCambridgeUK
  17. 17.Neurocritical Care Center, Cerebrovascular CenterUniversity Hospital Case Medical Center, Case Western Reserve University School of MedicineClevelandUSA
  18. 18.University of Cape Town, 617 Institute for Child Health, Red Cross Children’s HospitalCape TownSouth Africa
  19. 19.Mayo ClinicRochesterUSA
  20. 20.Neurocritical Care Unit, Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
  21. 21.University of Pennsylvania Health SystemPhiladelphiaUSA
  22. 22.Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
  23. 23.Department of Neurology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  24. 24.Nursing ResearchThe MetroHealth SystemClevelandUSA
  25. 25.Division of Cerebrovascular Diseases and Neurocritical CareThe Ohio State UniversityColumbusUSA
  26. 26.Department of NeurologyNorthwestern University FeinbergChicagoUSA
  27. 27.Department of Intensive Care Medicine, Faculty of Biology and Medicine University of LausanneCHUV University HospitalLausanneSwitzerland
  28. 28.Neurology, Neurotherapeutics and NeurosurgeryUniversity of Texas SouthwesternDallasUSA
  29. 29.Department of NeurologyUniversity of Miami, Miller School of MedicineMiamiUSA
  30. 30.Cerebrovascular Center and Neuroinflammation Research CenterLerner College of Medicine, Cleveland ClinicClevelandUSA
  31. 31.Intensive Care Unit, Hospital de ClinicasUniversidad de la RepúblicaMontevideoUruguay
  32. 32.Critical Care MedicineMaine Medical CenterMaineUSA
  33. 33.Department of Neurosurgery, Center for Neurosurgical Intensive CareBen Taub Hospital, Baylor College of MedicineHoustonUSA
  34. 34.Columbia University College of Physicians and SurgeonsNew YorkUSA
  35. 35.Laboratoire de Recherche Experimentale, Department of Intensive CareErasme HospitalBrusselsBelgium

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