Table 4.
Adherence to intensive care unit (ICU) Guideline indicators in 400 patients with severe traumatic brain injury at Jai Prakash Narayan Apex Trauma Center, New Delhi, India (N = 200) and Harborview Medical Center, Seattle, WA (N = 200).
| Indicators | JPNATC N (%) |
HMC N (%) |
|---|---|---|
| Adherence rate mean [SD] | 74.9 [11.0] | 71.6 [10.4] |
| 1) Hypoxia treated within 30 minutes after onset (Hypoxia - JPNATC [N = 2]; HMC [N = 10]) | 1 (50.0) | 7 (70.0) |
| 2) Hypotension treated within 30 minutes after onset (Hypotension - JPNATC [N = 2]; HMC [N = 82]) | 1 (50.0) | 55 (67.1) |
| 3) Intracranial pressure (ICP) monitor used | 126 (63.0) | 167 (83.5) |
| 4) All cerebral perfusion pressure between 50–70mmHg (Among those with ICP monitoring - JPNATC [N = 126]; HMC [N = 167]) | 119 (94.4) | 105 (62.9) |
| 5) Any treatment given for high ICP (clinical or by ICP monitors) (High ICP - JPNATC [N = 25]; HMC [N = 96]) | 13 (52.0) | 94 (97.9) |
| 6) Mannitol used for treatment of high ICP (High ICP - JPNATC [N = 25]; HMC [N = 96]) | 10 (40.0) | 52 (54.2) |
| 7) Propofol used for treatment of high ICP (High ICP - JPNATC [N = 25]; HMC [N = 96]) | 6 (24.0) | 91 (94.8) |
| 8) Prophylactic hyperventilation is not used for treatment of high ICP (High ICP - JPNATC [N = 25]; HMC [N = 96]) | 22 (88.0) | 96 (100) |
| 9) Target temperatures maintained (T 35–38.5°C) | 195(97.5) | 200 (100) |
| 10) Pre-intubation antibiotics used | 136 (68.0)* | 3 (1.5) |
| 11) Early tracheostomy performed | 5 (2.5) | 40 (20.0) |
| 12) Deep Vein Thrombosis (DVT) prophylaxis used | 110 (55.0) | 197 (98.5) |
| 13) Treatment thresholds of SJO2 ≥ 50% or PbrO2 ≥ 15 mmHg used (SJO2 or PbrO2 monitored - JPNATC [N = 3]; HMC [N = 64]) | 3 (100.0) | 37 (57.8) |
| 14) Prophylactic barbiturate coma not induced | 190 (95.0) | 194 (97.0) |
| 15) Prophylactic antiepileptic drugs used to prevent early seizures | 198 (99.0) | 83 (41.5) |
| 16) Nutrition† started within 72 hours | 188 (94.0) | 187 (93.5) |
| 17) No steroids used | 198 (99.0) | 199 (99.5) |
*
At JPNATC, 68% patients received antibiotics in the Emergency Department around the time of tracheal intubation.
†
Nutrition includes enteral, parenteral or combined.