Journal of Korean Academy of Nursing Administration (간호행정학회지)

Korean Academy of Nursing Administration (한국간호행정학회)
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Development of a Critical Pathway of Barbiturate Coma Therapy in the Management for Severe Brain Damage

중증 뇌 손상환자를 위한 바비튜레이트 혼수요법의 표준임상지침(Critical Pathway) 개발

  • Kim, Jung-Sook (Intensive Care Unit, Samsung Medical Center, Sungkyunkwan University Graduate School of Clinical Nursing Science)
  • 김정숙 (삼성서울병원 간호파트, 성균관대학교 임상간호대학원)
  • Published : 2010.03.31
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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

References

  1. Beare, P., & Myers, J. (1990). Clinical correlates of compensated and uncompensated phase of intracranial hypertension. In Principle and practice of adult nursing(ed 1) St Louis: Mosby.
  2. Beyea, S. C. (1996). Critical pathways for collaborative nursing care. New York: Addison-Wesley Nursing, A division of the Benjamin/Cummings Publishing.
  3. Bingaman, W. E., & Frank, J. I. (1995). Malignant cerebral edema and intracranial hypertension. Neurol Clin, 13(3), 479-509.
  4. Blaylock, B., & Murray, M. (1996). Case management: A new practices model for ET nurses. J WOCN, 23(2), 66-72.
  5. Bledsoe, K. A., & Kramer, A. H. (2008). Propylene glycol toxicity complicating use of barbiturate coma. Neurocrit Care, 9(1), 122-124. https://doi.org/10.1007/s12028-008-9065-z
  6. Bullock, R., Chesnut, R. M., Clifton, G., Ghajar, J., Marion, D. W., & Narayan, R. K., et al., (1996). Guidelines for the management of severe head injury. Brain Trauma Foundation. Eur J Emerg Med, 3(2), 109-127. https://doi.org/10.1097/00063110-199606000-00010
  7. Chen, H. I., Malhotra, N. R., Oddo, M., Heuer, G. G., Levine, J. M., & LeRoux, P. D. (2008). Barbiturate infusion for intractable intracranial hypertension and its effect on brain oxygenation. Neurosurgery, 63(5), 880-886; discussion 886-887. https://doi.org/10.1227/01.NEU.0000327882.10629.06
  8. Chung, K. H., Joo, J. L., & Chung, H. S. (2000). The effect of Critical Pathway on the patients with Cesarean section. J Korean Acad Nurs Admin, 6(2), 211-225.
  9. Dereeper, E., Berre, J., Vandesteene, A., Lefranc, F., & Vincent, J. L. (2002). Barbiturate coma for intracranial hypertension: Clinical observations. J Crit Care, 17(1), 58-62. https://doi.org/10.1053/jcrc.2002.33032
  10. Espinosa-Aguilar, A., Reyes-Morales, H., Huerta-Posada, C. E., de León, I. L., López-López, F., & Mejía-Hernández, M., et al. (2008). Design and validation of a critical pathway for hospital management of patients with severe traumatic brain injury, J Trauma, 64, 1327-1341. https://doi.org/10.1097/TA.0b013e3181469ebe
  11. Finfer, S. R., Ferch, R., & Morgan, M. K. (1999). Barbiturate coma for severe, refractory vasospasm following subarachnoid haemorrhage. Intensive Care Med, 25(4), 406-409. https://doi.org/10.1007/s001340050866
  12. Foley, N., Marshall, S., Pikul, J., Salter, K., & Teasell, R. (2008). Hypermetabolism following moderate to severe traumatic acute brain injury: A systematic review. J Neurotrauma, 25(12), 1415-1431. https://doi.org/10.1089/neu.2008.0628
  13. Gardetto, N. J., Greaney, K., Arai, L., Brenner, A., Carroll, K. C., & Howerton, N. M., et al. (2008). Critical pathway for the management of acute heart failure at the veterans affairs San Diego healthcare system: Transforming performance measures into cardiac care. Crit Pathw Cardiol, 7, 153-172. https://doi.org/10.1097/HPC.0b013e31818207e4
  14. Ghajar, J., Hariri, R. J., Narayan, R. K., Iacono, L. A., Firlik, K., & Patterson, R. H. (1995). Survey of critical care management of comatose, head-injured patients in the United States. Crit Care Med, 23(3), 560-567. https://doi.org/10.1097/00003246-199503000-00023
  15. Hong, S. O. (2000). A study on the development and application of critical pathway in Korea. Unpublished master's thesis, Hanyang University, Seoul.
  16. Jantzen, J. P. (2007). Prevention and treatment of intracranial hypertension. Baillieres Best Pract Res Clin Anaesthesiol, 21(4), 517-538. https://doi.org/10.1016/j.bpa.2007.09.001
  17. Jeevaratnam, D. R., & Menon, D. K. (1996). Survey of intensive care of severely head injured patients in the United Kingdom. Bmj, 312(7036), 944-947. https://doi.org/10.1136/bmj.312.7036.944
  18. Kim, J. S. (2010). Development of a critical pathway and its application for the management of subarachnoid hemorrhage. JKDAS, 12(1), 1-16.
  19. Kim, Y. I., Park, S. W., Nam, T. K., Park, Y. S., Min, B. K., & Hwang, S. N. (2008). The effect of barbiturate coma therapy for the patients with severe intracranial hypertension: a 10-year experience. J Korean Neurosurg Soc, 44(3), 141-145. https://doi.org/10.3340/jkns.2008.44.3.141
  20. Kokoska, E. R., Smith, G. S., Pittman, T., & Weber, T. R. (1998). Early hypotension worsens neurological outcome in pediatric patients with moderately severe head trauma. J Pediatr Surg, 33(2), 333-338. https://doi.org/10.1016/S0022-3468(98)90457-2
  21. Korean Neurosurgical Society. (2004). Neurosurgery: Increased intracranial pressure(3rd ed.). Seoul.
  22. Lee, M. W., Deppe, S. A., Sepperly, M. E., Marrette, R. R., & Thompson, D. R. (1994). The efficacy of barbiturate coma in the management of uncontroll the intracranial hypertension following neurosurgical trauma. J Neurotrauma, 11(3), 325-331. https://doi.org/10.1089/neu.1994.11.325
  23. Nussbaum, E., & Maggi, J. C. (1988). Pentobarbital therapy does not improve neurologic outcome in nearly drowned, flaccid-comatose children. Pediatrics, 81(5), 630-634.
  24. Orliaguet, G. A., Meyer, P. G., & Baugnon, T. (2008). Management of critically ill children with traumatic brain injury. Paediatr Anaesth, 18(6), 455-461. https://doi.org/10.1111/j.1460-9592.2008.02507.x
  25. Pearson, S. D., Goulart-Fisher, D., & Lee, T. H. (1995). Critical pathways as a strategy for improving care problems and potential. Annual of Internal Medicine, 123.
  26. Rappaport, M., Hall, K. M., Hopkins, K., Belleza, T., & Cope, D. N. (1982). Disability rating scale for severe head trauma: coma to community. Arch Phys Med Rehabil, 63(3), 118-23.
  27. Roberts, I. (2000). Barbiturates for acute traumatic brain injury. Cochrane Database Syst Rev(2), CD000033.
  28. Roh, J. S. (2004). Development of a Critical Pathway for Patients with Lobectomy and Pneumonectomy. J Korean Acad Nurs Admin, 10(3), 345-364.
  29. Sung, Y. H. (2000). Development of A Case management model and its application(for the laminectomy patients). Unpublished doctoral dissertation, Chung‐Ang University, Seoul.
  30. Zander, K. (1988). Nursing case management: Strategic management of cost and quality outcomes. J Nurs Adm, 18(5), 23-30.