Early sedation in traumatic brain injury: a multicentre international observational study

OBJECTIVES: We aimed to investigate the use of sedation in patients with severe traumatic brain injury (TBI), focusing on choice sedative agent, dose, duration, and their association clinical outcomes. DESIGN: Multinational, multicentre, retrospective observational study. SETTINGS: 14 trauma centres Europe, Australia United Kingdom. PARTICIPANTS: A total 262 adult TBI intracranial pressure monitoring. MAIN OUTCOME MEASURES: described how agents were used this population. The primary outcome was 60-day mortality according different agents. Secondary outcomes included intensive care unit hospital length stay, Extended Glasgow Outcome Scale at discharge. RESULTS: Propofol midazolam most commonly sedatives. more common than as first line therapy (35.4% v 25.6% respectively). Patients treated propofol had similar Acute Physiology Chronic Health Evaluation (APACHE) II International Mission for Prognosis Analysis Clinical Trials Traumatic Brain Injury (IMPACT) scores midazolam, but lower Severity Score (ISS) (median, 26 [IQR, 22–38] 34 26–44]; P = 0.001). heavier patients, strongly associated opioid co-administration (OR, 12.9; 95% CI, 3.47–47.95; < Sixty-day predicted by a higher IMPACT score (P 0.001) ISS 0.001), but, after adjustment, not related agent. CONCLUSIONS: often large doses both highly variable, affected severity, independently mortality.