Prehospital endotracheal intubation in patients with severe traumatic brain injury: Guidelines versus reality
| Autor: | Stephan A. Loer, Christa Boer, Gaby Franschman, J.M. Vieveen, Saskia M. Peerdeman, E. J. Toor, G.N. Jukema, H.M.T. Christiaans, S. Greuters, A.C.M. Brinkman |
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| Přispěvatelé: | Anesthesiology, Neurosurgery, Surgery, MOVE Research Institute, ICaR - Ischemia and repair |
| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Emergency Medical Services Traumatic brain injury medicine.medical_treatment Emergency Nursing Intensive care medicine Emergency medical services Intubation Intratracheal Intubation Humans Glasgow Coma Scale Intensive care medicine business.industry Medical record Middle Aged medicine.disease Prognosis Brain Injuries Practice Guidelines as Topic Emergency Medicine Injury Severity Score Airway management Female Guideline Adherence Cardiology and Cardiovascular Medicine business |
| Zdroj: | Resuscitation, 80(10), 1147-1151. Elsevier Ireland Ltd Franschman, G, Peerdeman, S M, Greuters, S, Vieveen, J M, Brinkman, A C M, Christiaans, H M T, Toor, E J, Jukema, G N, Loer, S A & Boer, C 2009, ' Prehospital endotracheal intubation in patients with severe traumatic brain injury: Guidelines versus reality ', Resuscitation, vol. 80, no. 10, pp. 1147-1151 . https://doi.org/10.1016/j.resuscitation.2009.06.029 |
| ISSN: | 0300-9572 |
| Popis: | The international Brain Trauma Foundation guidelines recommend prehospital endotracheal intubation in all patients with traumatic brain injury (TBI) and a Glasgow Coma Scale (GCS)≤8. Close adherence to these guidelines is associated with improved outcome, but not all severely injured TBI patients receive adequate prehospital airway support. Here we hypothesized that guideline adherence varies when skills are involved that rely on training and expertise, such as endotracheal intubation. We retrospectively studied the medical records of CT-confirmed TBI patients with a GCS≤8 who were referred to a level 1 trauma centre in Amsterdam ( n =127). Records were analyzed for demographic parameters, prehospital treatment modalities, involvement of an emergency medical service (EMS) and respiratory and metabolic parameters upon arrival at the hospital. Patients were mostly male, aged 45±21 years with a median injury severity score (ISS) of 26. Of all patients for whom guidelines recommend endotracheal intubation, only 56% were intubated. In 21 out of 106 severe cases an EMS was not called for, suggesting low guideline adherence. Especially those TBI patients treated by paramedics tended to develop higher levels of stress markers like glucose and lactate. We observed a low degree of adherence to intubation guidelines in a Dutch urban area. Main reasons for low adherence were the unavailability of specialized care, scoop and run strategies and absence of a specialist physician in cases where intubation was recommended. The discrepancy between guidelines and reality warrants changing practice to improve guideline compliance and optimize outcome in TBI patients. |
| Databáze: | OpenAIRE |
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