Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: A survey in 66 neurotrauma centers participating in the CENTER-TBI

Background: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. Methods: A 29-item survey on ICP monitoring and treatment was developed based on literature and expert opinion, and pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research (CENTER-TBI) study. Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals (n = 60, 91%) and designated level I trauma centers (n = 44, 67%). The Brain Trauma Foundation guidelines were used in 49 (74%) centers. Approximately ninety percent of the participants (n = 58) indicated placing an ICP monitor in patients with severe TBI and computed tomography abnormalities. There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as having a relatively aggressive approach to ICP monitoring and treatment (n = 32, 48%), whereas the others were considered more conservative (n = 34, 52%). Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with traumatic brain injury and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide an opportunity and necessity for comparative effectiveness research

SpecNet revisited: bridging flux and remote sensing communities

Spectral Network (SpecNet) began as a Working Group in 2003 with the goals of integrating remote sensing with biosphere-atmosphere carbon flux measurements and standardizing field optical sampling methods. SpecNet has evolved into an international network of collaborating sites and investigators, with a particular focus on matching optical sampling tools to the temporal and spatial scale of flux measurements and ecological sampling. Current emphasis within the SpecNet community is on greater automation of field optical sampling using simple cost-effective technologies, improving the light-use-efficiency (LUE) model of carbon dioxide flux, consideration of view and illumination angle to improve physiological retrievals, and incorporation of informatics and cyberinfrastructure solutions that address the increasing data dimensionality of cross-site and multiscale sampling. In this review, we summarize recent findings and current directions within the SpecNet community and provide recommendations for the larger remote sensing and flux communities. These recommendations include comparing the LUE model to other flux models driven by remote sensing, considering a wider array of biogenic trace gases in addition to carbon dioxide, adoption of standardized and automated field sensors and sampling protocols where possible, continued development of cyberinfrastructure tools to facilitate data comparison and integration, expanding the network itself so that a greater range of sites are covered by combined optical and flux measurements, and encouraging a broader communication between the flux and remote sensing communities