FROM SHOCK TO RECOVERY: RESOURCE-TIERED ICU BUNDLES FOR SEVERE TRAUMATIC BRAIN INJURY talhahbinislam@gmail.com

PE125

FROM SHOCK TO RECOVERY: RESOURCE-TIERED ICU BUNDLES FOR SEVERE TRAUMATIC BRAIN INJURY

1

United Kingdom

Poster Exhibition only

Outcomes after severe traumatic brain injury (TBI) hinge on consistent neurocritical care, yet ICU practices vary widely across settings. Objective: synthesise evidence for protocolised ICU bundles that reduce mortality and disability, and propose a pragmatic, resource-tiered bundle for adult severe TBI.

Scoping review (2014–2025) of MEDLINE, Embase, and Cochrane. Inclusion: adult severe TBI studies (RCTs, cohorts, guidelines, quality-improvement) evaluating ICU interventions or bundles. Outcomes: mortality, unfavourable GOS-E, intracranial hypertension episodes, ICU length of stay, complications. Risk of bias: RoB 2 / ROBINS-I. Evidence graded and grouped into a draft bundle with core (universally feasible) vs enhanced (monitoring-dependent) elements. Pre-specified domains: airway/ventilation, haemodynamics (CPP/MAP), sedation–analgesia, osmotherapy, temperature, seizure prophylaxis, thromboprophylaxis, nutrition, glycaemic control, infection prevention, nursing protocols, and monitoring (clinical vs ICP/CPP).

Planned outputs: (1) evidence map with effect direction and certainty; (2) summary-of-findings table; (3) bundle with target ranges and triggers (e.g., head elevation 30°, normoxia, normocapnia; CPP 60–70 mmHg when monitored; hyperosmolar bolus for ICP crises; early enteral feeding; fever control; selective levetiracetam for early seizure prevention). Elements likely not recommended: routine steroids, prophylactic hyperventilation, prophylactic hypothermia. Resource tiers: No-ICP (clinical targets), Basic ICP (EVD or intraparenchymal), Advanced (multimodal monitoring).

A standardised, resource-tiered ICU bundle for severe TBI is feasible and evidence-congruent, enabling safer, more consistent care across income settings. The poster will present a one-page checklist and order-set ready for local adaptation, with a proposed multicentre implementation study to test mortality and functional outcomes.