An additional interesting proposal

An additional interesting proposal from this protocol is a series of heat maps related to when to decrease the intensity of therapy based on medical exam and CT imaging in the first week of patient management in an ICU. As we present in our illustrative case, in areas where advanced neuromonitoring is not present, there is no specific guide regarding when to start decreasing sedation or other acute therapies such as muscle paralysis or osmotherapy. The proposed heat map divides the clinical evaluation based on motor score of the GCS and pupil reactivity (normal or abnormal) combined with the Marshall score of the CT scan, 24, 48 and 72 h after the injury. If the GCS is low or pupils are abnormal, they do not recommend cessation of sedation, especially if the CT Marshall score is high (>3). This recommendation remains mostly during the first 48 h and then if there are improvements in GCS or pupil reactivity or if the Marshal score decreases (