The research agenda for trauma critical care

Karim Asehnoune, Zsolt Balogh, Giuseppe Citerio, Andre Cap, Timothy Billiar, Nino Stocchetti, Mitchell J. Cohen, Paolo Pelosi, Nicola Curry, Christine Gaarder, Russell Gruen, John Holcomb, Beverley J. Hunt, Nicole P. Juffermans, Mark Maegele, Mark Midwinter, Frederick A. Moore, Michael O’Dwyer, Jean François Pittet, Herbert SchöchlMartin Schreiber, Philip C. Spinella, Simon Stanworth, Robert Winfield, Karim Brohi

    Research output: Contribution to journalReview article

    13 Citations (Scopus)

    Abstract

    In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factors (such as recombinant factor VIIa) and towards fibrinogen supplementation and administration of antifibrinolytics such as tranexamic acid. Novel diagnostic techniques need to be evaluated to determine whether an individualised precision approach is superior to current empirical practice. The timing and efficacy of platelet transfusions remain in question, while new blood products need to be developed and evaluated, including whole blood variants, lyophilised products and novel red cell storage modalities. The current cornerstones of TBI management are intracranial pressure control, maintenance of cerebral perfusion pressure and avoidance of secondary insults (such as hypotension, hypoxaemia, hyperglycaemia and pyrexia). Therapeutic hypothermia and decompressive craniectomy are controversial therapies. Further research into these strategies should focus on identifying which subgroups of patients may benefit from these interventions. Prediction of the long-term outcome early after TBI remains challenging. Early magnetic resonance imaging has recently been evaluated for predicting the long-term outcome in mild and severe TBI. Novel biomarkers may also help in outcome prediction and may predict chronic neurological symptoms. For trauma in general, rehabilitation is complex and multidimensional, and the optimal timing for commencement of rehabilitation needs investigation. We propose priority areas for clinical trials in the next 10 years.

    Original languageEnglish (US)
    Pages (from-to)1340-1351
    Number of pages12
    JournalIntensive Care Medicine
    Volume43
    Issue number9
    DOIs
    StatePublished - Sep 1 2017

    Fingerprint

    Critical Care
    Cerebrovascular Circulation
    Wounds and Injuries
    Rehabilitation
    Brain Concussion
    Decompressive Craniectomy
    Research
    Tranexamic Acid
    Induced Hypothermia
    Platelet Transfusion
    Antifibrinolytic Agents
    Blood Coagulation Factors
    Intracranial Pressure
    Hemostasis
    Hyperglycemia
    Hypotension
    Fibrinogen
    Fever
    Randomized Controlled Trials
    Biomarkers

    Keywords

    • Coagulopathy
    • Haemorrhage
    • Intracranial hypertension
    • Shock
    • Trauma
    • Traumatic brain injury

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine

    Cite this

    Asehnoune, K., Balogh, Z., Citerio, G., Cap, A., Billiar, T., Stocchetti, N., ... Brohi, K. (2017). The research agenda for trauma critical care. Intensive Care Medicine, 43(9), 1340-1351. https://doi.org/10.1007/s00134-017-4895-9

    The research agenda for trauma critical care. / Asehnoune, Karim; Balogh, Zsolt; Citerio, Giuseppe; Cap, Andre; Billiar, Timothy; Stocchetti, Nino; Cohen, Mitchell J.; Pelosi, Paolo; Curry, Nicola; Gaarder, Christine; Gruen, Russell; Holcomb, John; Hunt, Beverley J.; Juffermans, Nicole P.; Maegele, Mark; Midwinter, Mark; Moore, Frederick A.; O’Dwyer, Michael; Pittet, Jean François; Schöchl, Herbert; Schreiber, Martin; Spinella, Philip C.; Stanworth, Simon; Winfield, Robert; Brohi, Karim.

    In: Intensive Care Medicine, Vol. 43, No. 9, 01.09.2017, p. 1340-1351.

    Research output: Contribution to journalReview article

    Asehnoune, K, Balogh, Z, Citerio, G, Cap, A, Billiar, T, Stocchetti, N, Cohen, MJ, Pelosi, P, Curry, N, Gaarder, C, Gruen, R, Holcomb, J, Hunt, BJ, Juffermans, NP, Maegele, M, Midwinter, M, Moore, FA, O’Dwyer, M, Pittet, JF, Schöchl, H, Schreiber, M, Spinella, PC, Stanworth, S, Winfield, R & Brohi, K 2017, 'The research agenda for trauma critical care', Intensive Care Medicine, vol. 43, no. 9, pp. 1340-1351. https://doi.org/10.1007/s00134-017-4895-9
    Asehnoune K, Balogh Z, Citerio G, Cap A, Billiar T, Stocchetti N et al. The research agenda for trauma critical care. Intensive Care Medicine. 2017 Sep 1;43(9):1340-1351. https://doi.org/10.1007/s00134-017-4895-9
    Asehnoune, Karim ; Balogh, Zsolt ; Citerio, Giuseppe ; Cap, Andre ; Billiar, Timothy ; Stocchetti, Nino ; Cohen, Mitchell J. ; Pelosi, Paolo ; Curry, Nicola ; Gaarder, Christine ; Gruen, Russell ; Holcomb, John ; Hunt, Beverley J. ; Juffermans, Nicole P. ; Maegele, Mark ; Midwinter, Mark ; Moore, Frederick A. ; O’Dwyer, Michael ; Pittet, Jean François ; Schöchl, Herbert ; Schreiber, Martin ; Spinella, Philip C. ; Stanworth, Simon ; Winfield, Robert ; Brohi, Karim. / The research agenda for trauma critical care. In: Intensive Care Medicine. 2017 ; Vol. 43, No. 9. pp. 1340-1351.
    @article{504468f182c04272a62542d8bd8a3673,
    title = "The research agenda for trauma critical care",
    abstract = "In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factors (such as recombinant factor VIIa) and towards fibrinogen supplementation and administration of antifibrinolytics such as tranexamic acid. Novel diagnostic techniques need to be evaluated to determine whether an individualised precision approach is superior to current empirical practice. The timing and efficacy of platelet transfusions remain in question, while new blood products need to be developed and evaluated, including whole blood variants, lyophilised products and novel red cell storage modalities. The current cornerstones of TBI management are intracranial pressure control, maintenance of cerebral perfusion pressure and avoidance of secondary insults (such as hypotension, hypoxaemia, hyperglycaemia and pyrexia). Therapeutic hypothermia and decompressive craniectomy are controversial therapies. Further research into these strategies should focus on identifying which subgroups of patients may benefit from these interventions. Prediction of the long-term outcome early after TBI remains challenging. Early magnetic resonance imaging has recently been evaluated for predicting the long-term outcome in mild and severe TBI. Novel biomarkers may also help in outcome prediction and may predict chronic neurological symptoms. For trauma in general, rehabilitation is complex and multidimensional, and the optimal timing for commencement of rehabilitation needs investigation. We propose priority areas for clinical trials in the next 10 years.",
    keywords = "Coagulopathy, Haemorrhage, Intracranial hypertension, Shock, Trauma, Traumatic brain injury",
    author = "Karim Asehnoune and Zsolt Balogh and Giuseppe Citerio and Andre Cap and Timothy Billiar and Nino Stocchetti and Cohen, {Mitchell J.} and Paolo Pelosi and Nicola Curry and Christine Gaarder and Russell Gruen and John Holcomb and Hunt, {Beverley J.} and Juffermans, {Nicole P.} and Mark Maegele and Mark Midwinter and Moore, {Frederick A.} and Michael O’Dwyer and Pittet, {Jean Fran{\cc}ois} and Herbert Sch{\"o}chl and Martin Schreiber and Spinella, {Philip C.} and Simon Stanworth and Robert Winfield and Karim Brohi",
    year = "2017",
    month = "9",
    day = "1",
    doi = "10.1007/s00134-017-4895-9",
    language = "English (US)",
    volume = "43",
    pages = "1340--1351",
    journal = "Intensive Care Medicine",
    issn = "0342-4642",
    publisher = "Springer Verlag",
    number = "9",

    }

    TY - JOUR

    T1 - The research agenda for trauma critical care

    AU - Asehnoune, Karim

    AU - Balogh, Zsolt

    AU - Citerio, Giuseppe

    AU - Cap, Andre

    AU - Billiar, Timothy

    AU - Stocchetti, Nino

    AU - Cohen, Mitchell J.

    AU - Pelosi, Paolo

    AU - Curry, Nicola

    AU - Gaarder, Christine

    AU - Gruen, Russell

    AU - Holcomb, John

    AU - Hunt, Beverley J.

    AU - Juffermans, Nicole P.

    AU - Maegele, Mark

    AU - Midwinter, Mark

    AU - Moore, Frederick A.

    AU - O’Dwyer, Michael

    AU - Pittet, Jean François

    AU - Schöchl, Herbert

    AU - Schreiber, Martin

    AU - Spinella, Philip C.

    AU - Stanworth, Simon

    AU - Winfield, Robert

    AU - Brohi, Karim

    PY - 2017/9/1

    Y1 - 2017/9/1

    N2 - In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factors (such as recombinant factor VIIa) and towards fibrinogen supplementation and administration of antifibrinolytics such as tranexamic acid. Novel diagnostic techniques need to be evaluated to determine whether an individualised precision approach is superior to current empirical practice. The timing and efficacy of platelet transfusions remain in question, while new blood products need to be developed and evaluated, including whole blood variants, lyophilised products and novel red cell storage modalities. The current cornerstones of TBI management are intracranial pressure control, maintenance of cerebral perfusion pressure and avoidance of secondary insults (such as hypotension, hypoxaemia, hyperglycaemia and pyrexia). Therapeutic hypothermia and decompressive craniectomy are controversial therapies. Further research into these strategies should focus on identifying which subgroups of patients may benefit from these interventions. Prediction of the long-term outcome early after TBI remains challenging. Early magnetic resonance imaging has recently been evaluated for predicting the long-term outcome in mild and severe TBI. Novel biomarkers may also help in outcome prediction and may predict chronic neurological symptoms. For trauma in general, rehabilitation is complex and multidimensional, and the optimal timing for commencement of rehabilitation needs investigation. We propose priority areas for clinical trials in the next 10 years.

    AB - In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factors (such as recombinant factor VIIa) and towards fibrinogen supplementation and administration of antifibrinolytics such as tranexamic acid. Novel diagnostic techniques need to be evaluated to determine whether an individualised precision approach is superior to current empirical practice. The timing and efficacy of platelet transfusions remain in question, while new blood products need to be developed and evaluated, including whole blood variants, lyophilised products and novel red cell storage modalities. The current cornerstones of TBI management are intracranial pressure control, maintenance of cerebral perfusion pressure and avoidance of secondary insults (such as hypotension, hypoxaemia, hyperglycaemia and pyrexia). Therapeutic hypothermia and decompressive craniectomy are controversial therapies. Further research into these strategies should focus on identifying which subgroups of patients may benefit from these interventions. Prediction of the long-term outcome early after TBI remains challenging. Early magnetic resonance imaging has recently been evaluated for predicting the long-term outcome in mild and severe TBI. Novel biomarkers may also help in outcome prediction and may predict chronic neurological symptoms. For trauma in general, rehabilitation is complex and multidimensional, and the optimal timing for commencement of rehabilitation needs investigation. We propose priority areas for clinical trials in the next 10 years.

    KW - Coagulopathy

    KW - Haemorrhage

    KW - Intracranial hypertension

    KW - Shock

    KW - Trauma

    KW - Traumatic brain injury

    UR - http://www.scopus.com/inward/record.url?scp=85026484939&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85026484939&partnerID=8YFLogxK

    U2 - 10.1007/s00134-017-4895-9

    DO - 10.1007/s00134-017-4895-9

    M3 - Review article

    C2 - 28756471

    AN - SCOPUS:85026484939

    VL - 43

    SP - 1340

    EP - 1351

    JO - Intensive Care Medicine

    JF - Intensive Care Medicine

    SN - 0342-4642

    IS - 9

    ER -