Refractory increased intracranial pressure in severe traumatic brain injury: barbiturate coma and bispectral index monitoring.
Patients with severe traumatic brain injury resulting in increased intracranial pressure refractory to first-tier interventions challenge the critical care team. After exhausting these initial interventions, critical care practitioners may utilize barbiturate-induced coma in an attempt to reduce the intracranial pressure. Titrating appropriate levels of barbiturate is imperative. Underdosing the drug may fail to control the intracranial pressure, whereas overdosing may lead to untoward effects such as hypotension and cardiac compromise. Monitoring for a therapeutic level of barbiturate coma includes targeting drug levels and using continuous electroencephalogram monitoring, considered the gold standard. New technology, the Bispectral Index monitor, utilizes electroencephalogram principles to monitor the level of sedation and hypnosis in the critical care environment. This technology is now being considered for targeting appropriate levels of barbiturate coma.
Bader
Mary Kay
MK
Mission Hospital, Mission Viejo, CA, USA. Badermk@aol.com
Arbour
Richard
R
Palmer
Sylvain
S
D000328:Adult; D000465:Algorithms; D001930:Brain Injuries / Q000150:complications* / Q000628:therapy; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods* / Q000592:standards; D003663:Decision Trees; D016903:Drug Monitoring / Q000379:methods* / Q000451:nursing / Q000592:standards; D004569:Electroencephalography / Q000379:methods* / Q000451:nursing; D004576:Electromyography / Q000379:methods* / Q000451:nursing; D019317:Evidence-Based Medicine; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D009460:Neurologic Examination / Q000379:methods / Q000451:nursing; D009730:Nursing Assessment; D018579:Patient Selection; D010424:Pentobarbital / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012815:Signal Processing, Computer-Assisted; D015599:Trauma Severity Indices; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D010424:Pentobarbital