Table 15.
ICU-level supportive interventions. Abbreviations: RASS = Richmond Agitation-Sedation Scale; GCS = Glasgow Coma Scale; FOUR = Full Outline of Un Responsiveness score; EEG = Electroencephalogram; ICP = Intracranial Pressure; PbtO2 = Brain Tissue Oxygen Pressure; PT = Prothrombin Time; PTT = Partial Thromboplastin Time; Hb = Hemoglobin; CT = Computed Tomography; K = Potassium; Mg = Magnesium; Cl = Chloride.
| Cardioscope |
| Pulse oximeter |
| Capnography |
| Invasive blood pressure measurement |
| Jugular bulb catheter |
| Urinary catheter |
| Sedation assessment according to the RASS scale |
| Neurological status assessment using GCS or FOUR score |
| Monitor the clinical status of the patient with an emphasis on pupillary reactivity, and motor deficit |
| It is recommended to use continuous EEG if available, especially in patients with unexplained altered consciousness, or patients with GCS ≤8 with cortical injury, depressed fracture, or penetrating injury |
| Assess vital signs every hour |
| Monitoring the temperature: It is recommended to measure the central temperature if available, otherwise perform the axillary temperature measurement |
| Glucose monitoring every 4 h |
| Monitoring daily sodium except if the patient has osmotic therapy or if the patient does not have disnatremias |
| Monitoring of K, Mg, Cl daily or at physician's discretion |
| Coagulation monitoring is recommended, including Thromboelastography, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen levels, and platelet count. These parameters should be reassessed if initial results are abnormal or if clinically indicated |
| Monitoring Hb levels every day |
| Invasive ICP and PbtO2 neuromonitoring if available and indicated |
| Non-invasive neuromonitoring if available and indicated |
| Urinary output between 0.5 and 3 mL/kg/h |
| Monitor the onset of seizures, and if it has EEG indications |
| Preserve the clinical neurological condition of the patient and before a change of GCS more than 2 points perform evaluation by images |
| Initiate enteral nutrition early. Evaluate tolerance and without contraindications |
| Initiate mechanical prophylaxis in the first 24 h. And then, pharmacological thrombus prophylaxis after 24 h if there are no hemorrhagic lesions and after 72 h if the hemorrhagic lesions are stable in the CT scan |
| Evaluation and rehabilitation, according to the patient's condition in the first 48 h |