Current Practices for Intracranial Pressure and Cerebral Oxygenation Monitoring in Severe Traumatic Brain Injury: A Latin American Survey

Appendices

Appendix 1: Survey Questions

ICP and Cerebral Oxygenation monitoring in severe TBI in Latin America. What is our current reality?

1. Where do you usually carry out your clinical activity?

• Public hospital

• Private hospital

• Academic hospital

• Other

2. In what type of Intensive Care Unit do you carry out your activity?

• Polyvalent

• Trauma ICU

• Neurocritical care

• Other

3. How many severe TBI (GCS < 9/15) do you attend each year?

• Less than 25

• 25–50

• 51–75

• 76–100

• More than 100

4. In patients with severe TBI, do you monitor ICP invasively?

• Yes

• No

5. If the previous response is yes, what percentage of patients with severe TBI who indicate ICP monitoring has some monitoring system installed?

• Less than 25%

• 25–50%

• 50–75%

• 75–99%

• 100%

6. What type of ICP monitoring do you use most often?

• Intraventricular probe

• Intraparenchymal probe

• Subdural probe

• Epidural probe

7. In patients with intracranial hypertension, do you routinely follow the "Brain Trauma Foundation" recommendations"?

• Yes

• No

8. In patients where invasive ICP monitoring is not installed, do you use any protocol for managing intracranial hypertension?

• Yes

• No

9. Do you follow protocol or recommendations for the withdrawal of invasive intracranial pressure monitoring?

• Yes

• No

10. In severe TBI patients, do you monitor Cerebral Oxygenation?

• Yes

• No

11. If your answer to the previous question is YES, what tissue oxygenation monitoring method do you use?

• SyjO2

• NIRS

• PtiO2

• PtiO2

12. If you consider installing some cerebral oxygenation monitoring, in what percentage of severe TBI do you use it?

• Less than 10%

• 10–25%

• 26–50%

• More than 50%

13. If PtiO2 is available, where is it put on?

• Penumbra (perilesional) injured hemisphere

• Healthy tissue injured hemisphere

• Non-injured hemisphere

• PtiO2 is not available

14. In patients in whom monitoring cerebral oxygenation is installed, do you follow any protocol for the management of cerebral tissue hypoxia?

• Yes

• No

15. When do you decide to monitor tissue oxygenation if you install the device together with ICP monitoring?

• Same time with ICP monitoring

• ICP independently

16. Who directs the management of intracranial hypertension and brain tissue hypoxia?

• Neurologist

• Neurosurgeon

• Intensivist

• Anesthesiologist

17. In which country do you carry out your clinical activity?

Appendix 2: Tables for Survey Answers

	N	%	Cumulative percentage
Q1. Where do you usually carry out your clinical activity?
Public hospital	326	54.5	54.7
Private hospital	184	30.8	85.6
Academic hospital	80	13.4	99.0
Other	6	1.0	100.0
Total	596	99.7
Q2. In what type of Intensive Care Unit do you carry out your activity?
Polyvalent	487	81.4	81.7
Trauma ICU	29	4.8	86.6
Neurocritical care	54	9.0	95.6
Other	26	4.3	100.0
Total	596	99.7
Q3. How many severe TBI (GCS < 9/15) do you attend each year?
Less than 25	240	40l1	40.3
25–50	186	31.1	71.5
51–75	74	12.4	83.9
76–100	32	5.4	89.3
More than 100	64	10.7	100.0
Total	596	100.0
Q4. In patients with severe TBI, do you monitor ICP invasively?
Yes	316	53.0	53.1
No	280	46.8	100.0
Total	596	100.0
Q5. If the previous response is yes, what percentage of patients with severe TBI who indicate ICP monitoring has some monitoring system installed?
Less than 25%	289	48.3	49.2
25–50%	106	17.7	67.3
50–75%	77	12.9	80.4
75–99%	73	12.2	92.8
100%	42	7.0	100.0
Total	587	98.2
Q6. What type of ICP monitoring do you use most often?
Intraventricular probe	364	66.4
Intraparenchimatous probe	136	24.8	91.2
Subdural probe	38	6.9	98.2
Epidural probe	10	1.8	100.0
Total	548	100.0
Q7. In patients with intracranial hypertension, do you routinely follow the "Brain Trauma Foundation" recommendations"?
Yes	476	80.5	80.5
No	115	19.5	100.0
Total	591	100.0
Q8. In patients where invasive ICP monitoring is not installed, do you use any protocol for managing intracranial hypertension?
Yes	472	79.7	79.7
No	120	20.3	100.0
Total	592	100.0
Q9. Do you follow protocol or recommendations for the withdrawal of invasive intracranial pressure monitoring?
Yes	415	71.8	71.8
No	163	28.2	100.0
Total	578	100.0
Q10. In severe TBI patients, do you monitor Cerebral Oxygenation?
Yes	87	55.8	55.8
No	69	44.2	100.0
Total	156	100.0
Q11. If your answer to the previous question was YES, what tissue oxygenation monitoring method do you use?
SyjO2	47	52.2	52.2
NIRS	18	20.0	72.2
PtiO2	13	14.4	86.7
None	3	3.3	90.0
Two or more	9	10.0	100.0
Total	90	100.0
Q12. If you consider installing some cerebral oxygenation monitoring, what percentage of severe TBI do you use it?
Less than 10%	43	32.3	32.3
10–25%	26	19.5	51.9
26–50%	22	16.5	68.4
More than 50%	42	31.6	100.0
Total	133	100.0
Q13. If PtiO2 available, where is it put on?
Penumbra (perilesional) injured hemisphere	54	77.1	77.1
Healthy tissue injured hemisphere	9	12.9	90.0
Non-injured hemisphere	7	10.0	100.0
Total	70	100.0
Q14. In patients in whom monitoring cerebral oxygenation is installed, do you follow any protocol for the management of cerebral tissue hypoxia?
Yes	60	51.3	51.3
No	57	48.7	100.0
Total	117	100.0
Q15. When do you decide to monitor tissue oxygenation you install the device together with ICP monitoring?
Same time with ICP monitoring	93	75.6	75.6
ICP independently	30	24.4	100.0
Total	123	100.0
Q16. Who directs the management of intracranial hypertension and brain tissue hypoxia?
Neurologist	2	1.5	1.5
Neurosurgeon	7	5.2	6.7
Intensivist	126	93.3	100.0
Total	135	100.0
Q17. In which country do you carry out your clinical activity?
Argentina	71	12.1	12.1
Colombia	113	19.3	31.5
Chile	31	5.3	36.8
Perú	74	12.6	49.4
Ecuador	56	9.6	59.0
Brazil	31	5.3	64.3
Costa Rica	19	3.2	67.5
Paraguay	29	5.0	72.5
Uruguay	17	2.9	75.4
Venezuela	30	5.1	80.5
Honduras	3	0.5	81.0
Guatemala	16	2.7	8.8
México	54	9.2	93.0
El Salvador	1	0.2	93.2
Panamá	7	1.2	94.4
Other	14	2.4	96.8
Bolivia	17	2.9	99.7
Cuba	2	0.3	100.0
Total	585	100.0
Unaswered	11