Evidence map›Paper›PMID 39138718›Full record

ArticleNeurocritical care2025

Sedation Intensity in Patients with Moderate to Severe Traumatic Brain Injury in the Intensive Care Unit: A TRACK-TBI Cohort Study.

Rianne G F Dolmans, Jason Barber, Brandon Foreman, Nancy R Temkin, David O Okonkwo, Claudia S Robertson, Geoffrey T Manley, Eric S Rosenthal

Erratum issuedAbstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Neurocritical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Observational
  5. Update on traumatic brain injury in the ICU.Current opinion in anaesthesiology · 2025
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Rianne G F DolmansDepartment of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA. rianne.dolmans@freeler.nl.ORCID 0000-0002-3010-7111
Jason BarberDepartment of Neurological Surgery, University of Washington, Seattle, WA, USA.
Brandon ForemanDepartment of Neurology and Rehabilitation Medicine, University of Cincinnati and, University of Cincinnati Medical Center, Cincinnati, OH, USA.
Nancy R TemkinDepartment of Neurological Surgery, University of Washington, Seattle, WA, USA.
David O OkonkwoDepartment of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Claudia S RobertsonDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
Geoffrey T ManleyDepartment of Neurosurgery, University of California San Francisco, San Francisco, CA, USA.
Eric S RosenthalDepartment of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.

Funding

Transforming Research and Clinical Knowledge in Traumatic Brain InjuryU01NS086090 · NINDS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI DIAZ-ARRASTIA, RAMON, GIACINO, JOSEPH THOMAS · 2013 to 2017
$19.1M
The Impact of Intracranial Pressure on Cortical Functioning and Cognitive Outcome after Traumatic Brain InjuryK23NS101123 · NINDS · UNIVERSITY OF CINCINNATI · PI FOREMAN, BRANDON · 2017 to 2020
$797k
Quantitative Diffuse Correlation Spectroscopy for Assessing Human Brain FunctionR01EB031759 · NIBIB · WRIGHT STATE UNIVERSITY · PI SUNAR, ULAS · 2021 to 2022
$723k
Department of Defense JW200215Department of Defense W81XWH-14-2-0176NIBIB NIH HHS R01 EB031759NINDS NIH HHS K23 NS101123NINDS NIH HHS U01 NS086090
6 · The paper itself

Abstract

backgroundInterventions to reduce intracranial pressure (ICP) in patients with traumatic brain injury (TBI) are multimodal but variable, including sedation-dosing strategies. This article quantifies the different sedation intensities administered in patients with moderate to severe TBI (msTBI) using the therapy intensity level (TIL) across different intensive care units (ICUs), including the use of additional ICP-lowering therapies.

methodsWithin the prospective Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study, we performed a retrospective analysis of adult patients with msTBI admitted to an ICU for a least 5 days from seven US level 1 trauma centers who received invasive ICP monitoring and intravenous sedation. Sedation intensity was classified prospectively as one of three ordinal levels as part of the validated TIL score, which were collected at least once a day.

resultsA total of 127 patients met inclusion criteria (mean age 41.6 ± 17.7 years; 20% female). The median Injury Severity Score was 27 (interquartile range 17-33), with a median admission Glasgow Coma Score of 3 (interquartile range 3-7); 104 patients had severe TBI (82%), and 23 patients had moderate TBI (18%). The sedation intensity score was highest on the first ICU day (2.69 ± 1.78), independent of patient severity. Time to reaching each sedation intensity level varied by site. Sedation level I was reached within 24 h for all sites, but sedation levels II and III were reached variably between days 1 and 3. Sedation level III was never reached by two of seven sites. The total TIL score was highest on the first ICU day, with a modest decrease for each subsequent ICU day, but there was high site-specific practice-pattern variation.

conclusionsIntensity of sedation and other therapies for elevated ICP for patients with msTBI demonstrate large practice-pattern variation across level 1 trauma centers within the TRACK-TBI cohort study, independent of patient severity. Optimizing sedation strategies using patient-specific physiologic and pathoanatomic information may optimize patient outcomes.

Indexed as

Brain Injuries, TraumaticHypnotics and SedativesIntensive Care UnitsIntracranial HypertensionIntracranial PressureProcedural SedationAdultCohort StudiesFemaleHumansInjury Severity ScoreMaleMiddle AgedRetrospective StudiesTrauma CentersHypnotics and SedativesNeurocritical careNeurotraumaSedationTherapy intensity levelTraumatic brain injury

Identifiers

PMID39138718

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.