Article

The agitation crisis in the awakening phase after traumatic brain injury (TBI) is
one of the most difficult behavioral disorders to alleviate. Current treatment
options are heterogeneous and may involve excessive sedation. Practice guidelines
are required by professionals in charge of TBI patients.
Few reviews were
published but those are old and based on expert opinions.
The purpose of this
work is to propose evidence-based guidelines to treat the agitation crisis.
METHODS: The elaboration of these guidelines followed the procedure validated by
the French health authority for good practice recommendations, close to the
Prisma statement. Guidelines were elaborated on the basis of a systematic and
critical review of the literature. RESULTS: Twenty-eight articles concerning 376
patients were analyzed. Recommendations are: when faced with an agitation crisis,
the management strategy implies to search for an underlying factor that should be
treated such as pain, acute sepsis, and drug adverse effect (expert opinion).
Physical restraints should be discarded when possible (expert opinion).
Neuroleptic agent with a marketing authorization can be used in order to obtain a
quick sedation so as to protect the patient from himself, closed ones or the
healthcare team but the duration should be as short as possible (expert opinion).
The efficacy of beta-blockers and antiepileptics with mood regulation effects
like carbamazepine and valproate yield the most compelling evidence and should be
preferably used when a background regimen is envisioned (grade B for beta-blocker
and C for antiepileptics). Neuroleptics, antidepressants, benzodiazepines,
buspirone may be prescribed but are considered second-line treatments (expert
opinion). CONCLUSION: This study provides a strategy for treating the agitation
crisis based on scientific data and expert opinion. The level of evidence remains
low and published data are often old. New studies are essential to validate
results from previous studies and test new drugs and non-pharmaceutical
therapies.
CI - Copyright (c) 2015 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS