Page 542 - Clinical Application of Mechanical Ventilation

508 Chapter 15

TABLE 15-9 Glasgow Coma Scale

Eye Opening

Score 1 year to adult ,1 year

4 Spontaneous Spontaneous
3 To verbal command To shout

2 To pain To pain

1 No response No response
Best Motor Response

Score 1 year to adult ,1 year
6 Obeys command

5 Localizes pain Localizes pain
4 Flexion withdrawal Flexion withdrawal

3 Flexion abnormal Flexion abnormal decorticate: arms flexed or bent in-
(decorticate) (decorticate) ward on the chest, clenched fists, legs
extended and feet turned inward.
2 Extension (decerebrate) Extension (decerebrate) decerebrate: head arched back, arms
extended by the sides, legs extended
1 No response No response

Best Verbal Response*
Score 5 years to adult 2–5 years ,2 years

5 Oriented and converses Appropriate words Cries appropriately

4 Disoriented and converses Inappropriate words Cries
3 Inappropriate words; cries Screams Inappropriate cry/scream

2 Incomprehensible sounds Grunts Grunts

1 No response No response No response

*Verbal scores cannot be assessed in intubated patients. The maximal score for intubated patients is 10T and the minimal score is 2T (T is used to
designate intubation).
Modified from: Crippen, D.W. (2011).
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Respiratory management

To manage TBI during
mechanical ventilation, the
PaCO 2 may be titrated to a Patients with severe TBI should be sedated to prevent coughing or ventilator-patient
level as low as 26 torr during dyssynchrony because these conditions tend to increase the intracranial pressure.
the first 24 hours of mechani-
cal ventilation. Endotracheal suctioning should be avoided or the frequency of suctioning should
be minimized. If mechanical ventilation is used, the PaCO may be reduced to
2

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