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Quantifying nursing care in barbiturate-induced coma with the therapeutic intervention scoring system
G L Myles1, A G Perry, M D Malkoff
1Saint Louis University Health Sciences Center, Department of Neurology, Missouri 63110-0250, USA.
Summary
Pentobarbital-induced coma effectively manages intractable increased intracranial pressure in brain-injured patients. This treatment requires intensive monitoring and interventions, as quantified by the Therapeutic Intervention Scoring System (TISS).
Area of Science:
- Neuroscience
- Critical Care Medicine
Background:
- Intractable increased intracranial pressure (IICP) poses a significant challenge in acute brain injury.
- Pentobarbital-induced coma is a recognized therapeutic option for managing IICP.
Purpose of the Study:
- To evaluate the intensity of medical interventions and nursing care required during pentobarbital-induced coma for IICP.
- To assess the utility of the Therapeutic Intervention Scoring System (TISS) in quantifying care needs in this patient population.
Main Methods:
- Retrospective review of 15 patients with neurological injuries treated with pentobarbital coma.
- Application of the Therapeutic Intervention Scoring System (TISS) to score interventions before, during, and after barbiturate coma.
Main Results:
- Pentobarbital coma necessitates aggressive management of respiratory, hemodynamic, metabolic, and neurological status.
- TISS scores significantly increased during pentobarbital coma (mean 41.7) compared to pre-treatment (31.8) and post-treatment (36.4) phases (p < 0.01).
Conclusions:
- Pentobarbital-induced coma is a viable treatment for IICP, requiring substantial and quantifiable nursing and medical interventions.
- Modifications to the TISS, incorporating advanced neuroscience monitoring, could enhance its utility in critical care settings.