Quantifying nursing care in barbiturate-induced coma with the therapeutic intervention scoring system.

Abstract

The use of pentobarbital-induced coma to manage intractable increased intracranial pressure remains a viable option in the acutely brain-injured patient. In a retrospective review of 15 patients with a variety of neurological injuries at our institution, it was found that aggressive management of respiratory, hemodynamic, metabolic and neurological status was required with the use of pentobarbital coma. A scoring system to determine the amount of interventions and nursing care required was used in the review. The Therapeutic Intervention Scoring System (TISS) demonstrated that with the acuity of illness, there were predictably increased interventions. As a method for quantifying the amount of care in this group of individuals, scoring of the interventions before, during, and after barbiturate coma was assessed. The findings demonstrated a significant difference in the scoring. Mean scores were: pre-treatment = 31.8, s.d. = 7.5; during = 41.7, s.d. = 2.0; post-treatment = 36.4, s.d. = 5.2, p < 0.01. Further modifications of the TISS to include current neuroscience therapies, such as the monitoring of cerebral oxygen extraction by jugular bulb catheterization, may increase the utility of the TISS.