Development of a Critical Pathway of Barbiturate Coma Therapy in the Management for Severe Brain Damage

Jung Sook Kim

doi:10.11111/jkana.2010.16.1.59

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Kim: Development of a Critical Pathway of Barbiturate Coma Therapy in the Management for Severe Brain Damage

Original Article

Journal of Korean Academy of Nursing Administration

Journal of Korean Academy of Nursing Administration 2010; 16(1): 59-72.

Published online: 31 March 2010

DOI: https://doi.org/10.11111/jkana.2010.16.1.59

Development of a Critical Pathway of Barbiturate Coma Therapy in the Management for Severe Brain Damage

Jung Sook Kim¹

¹Nursing Director, Intensive Care Unit, Samsung Medical Center; Concurrent Professor, Sungkyunkwan University Graduate School of Clinical Nursing Science, Korea.

Correspondence: Kim, Jung Sook. Samsung Medical Center, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. Tel: 82-2-3410-0671, C.P.: 82-10-9933-0671, Fax: 82-2-3410-0650, freefives@naver.com

Received 19 February 2010 Revised 24 February 2010 Accepted 16 March 2010

Abstract

Purpose

This study is a descriptive research to analyze prognostic factors of barbiturate coma therapy (BCT) for severe brain damage patients, to develop a critical pathway (CP) based on the results of analysis and to examine the effect of its clinical application.

Method

We analyzed medical records of 76 patients who received BCT for more than three days between January 1999 to July 2005. Based on the results of the analysis, we developed a CP and applied it to 12 people during August-December of 2005.

Result

By application of BCT CP, the mortality rate decreased from 31.6% to 16.7%. It was found that the period of staying at ICU and total period of hospitalization were shortened by 2.78 (13.9%) days and 16.43 (29.4%) days, respectively. The Glasgow coma scale of the recovery group by CP application was 9.03 (4.64) at 72 hours post of BCT and 14.28 (1.82) at discharge from hospital, and DRS was 6.62 (6.38) points.

Conclusion

By verifying clinical validity of the suggested CP, we believe that we have obtained visible effects standardizing the treatment pathway of BCT for brain damage patients.

Keywords: Barbiturate coma therapy, Critical pathway, Brain injury

Figures and Tables

Figure 1

Critical pathway of barbiturate coma therapy

[Abbreviations] A/C and D/B=Active coughing and Deep breathing; AFO=Ankle foot orthopedic; B/S=Bowel sound; BST=Blood sugar test; N/S=Normal saline; CPP=Cerebral perfusion pressure; CSF=Cerebrospinal fluid; CVP=Central venous pressure; DVT=Deep vein thrombosis; EVD=External ventricular drainage; GCS=Glasgow coma scale; I/O=Intake/Output; IPC=Intermittent pneumatic compressor; L/M=Limb motor; L/R=Light reflex; MBP=Mean blood pressure; ND=Natural drainage; Pb=Pentobarbital; PEEP=Positive end expiratory pressure; P/S=Pupil size; RH=Rehabilitation; R/V=Residual volume. T/P=T-piece; USG=Urine specific gravity.

Table 1

Based on analysis of medical records on critical pathway change

ATS=According to situation; B/S=Bowel sound; BT=Body temperature; CPP=Cerebral perfusion pressure;

CVP=Central venous pressure; ICP=Intra cranial pressure; MBP=Mean blood pressure; Pb=Pentobarbital; TS=Time schedule.

Table 2

Analysis on the variation of barbiturate coma therapy (N=76)

CPP=Cerebral perfusion pressure; CVP=Central venous pressure; GCS=Glasgow coma scale; MBP=Mean blood pressure;

Pb=Pentobarbital; S-Na Serum Na(mEq/l); S-Osmol=Serum osmolarity(mOsm/l).

Table 3

General characteristics of patients (N=88)

^*Fisher's exact test

APACHE II=Acute Physiology and Chronic Health Evaluation II; CPICH=Clinical phase of intracranial hypertension;

GCS=Glasgow coma scale; SAH=Subarachnoid hemorrhage.

Table 4

Comparison on intervention of critical pathway between two groups (N=88)

CPP=Cerebral Perfusion Pressure; CVP=Central venous pressure; MBP=Mean blood pressure;

P/S & L/R=Pupil size & light reflex; SBP=Systolic blood pressure

Table 5

Comparison on the outcomes of Barbiturate coma therapy between two groups (N=88)

^*Survival group=Control(n=52); CP apply(n=10)

DRS=Disability rating scale; GCS=Glasgow coma scale; ICU=Intensive care unit.

Notes

This article is a revision of the author's doctoral dissertation from Chung-Ang University.

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