Consensus recommendations for the management of traumatic brain injury at altitude (COMATEC-ALTITUDE) from the Expert Committee on Altitude Intensive Care of the Pan-American and Iberian Federation of Critical Care and Intensive Therapy

Avila-Hilari A.; Barea Mendoza J.A.; Avellanas-Chavala M.L.; Vélez-Páez J.; Nieto Estrada V.H.; Montelongo F.D.J.; Tinoco-Solórzano A.; Eduardo Kessler M.H.; Maldonado Coronel F.; Molano Franco D.; Huanca Payehuanca R.; Sánchez Medina J.R. · Acta Colombiana de Cuidado Intensivo (2026) · DOI: 10.1016/j.acci.2026.100615

Resumen

Introduction: The management of severe traumatic brain injury is well established at sea level; however, its application at high altitude poses additional challenges due to hypobaric hypoxia and limited healthcare resources, particularly in neuromonitoring. Evidence in this setting remains scarce and heterogeneous. Objective: To develop clinical recommendations for the diagnosis, monitoring, and management of traumatic brain injury at altitude, adapted to altitude-related physiology and resource-limited settings. Methods: A modified Delphi consensus was conducted. A non-systematic literature review was performed across major biomedical databases (PubMed, Embase, Scielo, Cochrane Library, among others) and grey literature, identifying 125 relevant references. A multidisciplinary panel of 12 international experts evaluated 36 recommendations using a 9-point Likert scale. Consensus was defined as ≥ 80% agreement (scores ≥ 7). Recommendations were graded based on strength and quality of evidence using a previously validated system for critical care consensus, given the limited altitude-specific evidence. Results: A total of 36 recommendations across 10 clinical domains were developed. After 2 Delphi rounds, all recommendations achieved consensus (≥ 80%). Twenty recommendations were supported by altitude-specific evidence, while the remainder were adapted from sea-level guidelines. Key domains included hemodynamic resuscitation, altitude-adjusted oxygenation and ventilation strategies, osmotic therapy, and multimodal neurological monitoring, with emphasis on non-invasive techniques when invasive monitoring is unavailable. Conclusions: This consensus provides a structured clinical framework for managing traumatic brain injury at altitude, integrating the best available evidence and expert opinion. It serves as a practical tool for high-altitude settings, particularly in resource-limited environments, and highlights the need for further research in this field.

Instituciones: Universidad de San Martín de Porres