SCCM Resource Library-Neurocritical Care Guideline Updates for the Intensivist

Pdf Summary

The document provides updates on neurocritical care guidelines focusing on targeted temperature management (TTM) and the reversal of antithrombotic agents in intracranial hemorrhage (ICH). Targeted Temperature Management (TTM) is crucial post-cardiac arrest, recommending a target temperature between 32°C and 36°C for at least 24 hours to improve neurological outcomes. These guidelines stress using controlled cooling techniques and highlight areas with insufficient evidence, such as ideal cooling duration and drug metabolism impacts.<br /><br />Guidelines for antithrombotic reversal, issued by the Neurocritical Care Society and the Society of Critical Care Medicine in 2016, address management strategies for patients on various anticoagulants, including vitamin K antagonists, factor Xa inhibitors, and thrombin inhibitors. Reversal strategies prioritize using prothrombin complex concentrates (PCCs) over fresh-frozen plasma for quicker coagulopathy reversal in vitamin K antagonist cases. Recent developments include FDA approval of coagulation factor Xa-[recombinant]inactivated-zhzo for specific inhibitor reversals, reflecting the dynamic nature of best practices.<br /><br />The guidelines emphasize individualized clinical decision-making due to variability in antithrombotic agent effects and limited evidence guiding newer drug reversals. Recommendations caution against routine platelet transfusions for ICH in patients on antiplatelets unless a procedure is imminent. Since publication, new studies, such as the PATCH trial, further guide these decisions by showing that platelet transfusions can detrimentally affect functional outcomes.<br /><br />Overall, clinical practice guidelines (CPGs) are consensus documents that need periodic updating to incorporate new evidence. They serve as valuable resources for clinicians but should be critically appraised and tailored to individual patient contexts prior to implementation. The guidelines discussed offer essential recommendations for TTM and antithrombotic reversal in neurocritical care, reflecting current best practices.

Asset Subtitle

Neuroscience, Quality and Patient Safety, 2020, 4:40:00

Asset Caption

This is a complimentary chapter from the textbook, Current Concepts in Adult Critical Care 2020), titled "Neurocritical Care Guideline Updates for the Intensivist: Targeted Temperature Management and Antithrombotic Reversal in Intracranial Hemorrhage."

Learning Objectives:

Discuss the World Health Organization and National Academy of Medicine standards for guideline development.
Review key guideline updates over the past several years in neurocritical care.
Apply key guideline updates to clinical care of patients with critical neurological illness.

Meta Tag

Content Type Book Chapter

Knowledge Area Neuroscience

Knowledge Area Quality and Patient Safety

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Neurology

Tag Guidelines

Year 2020

Keywords

neurocritical care

targeted temperature management

intracranial hemorrhage

antithrombotic reversal

clinical practice guidelines

prothrombin complex concentrates

coagulation factor Xa

individualized decision-making

platelet transfusions

neurocritical care guidelines

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