Management of sedation in severe traumatic brain injury: A national survey

Sedation is a central therapeutic for patients presenting severe traumatic brain injury. Management of sedation in this population is not consensual and fewdata are available. We conducted a national survey. A questionnaire was sent in April and May 2017 to physicians identified as working in a specialised neuro-intensive care unit from a register of the French Association of neuro-anaesthesiology and critical care. In total, 149 of the 277 physicians returned the questionnaire (58.3%). In initial sedation, midazolam was the first choice for hypnotic (79.9%) whereas propofol was prescribed by 20.1% of the responders. For analgesia, intravenous opioids were the only drugs administered. Early neurological test was considered by most of physicians (85.6%) but criteria required to perform this test were not consensual. In patients with persistent intracranial hypertension, propofol was the most frequently used drug (43.6%) ahead of barbiturates. Timing and strategies for sedation weaning were multiple. The most popular strategy was to progressively decrease sedation and to perform sedation shifts. Alpha-2 agonists and opioids were the most frequently used molecules in this indication. In severe traumatic brain injury, practices reported are highly heterogeneous, reflecting the lack of evidence of the current guidelines and underlying the need to further study this subject.