CriticalMindAI — Critical Care Clinical Intelligence Platform

Clinical Protocols

Structured clinical checklists and timeline-based protocols for the early tracheostomy and PUG intervention pathway in the NeuroICU.

Intervention Timeline

Days 0–2 — Initial Assessment: Admission screening for eligibility, baseline neurological assessment (GCS), documentation of bulbar dysfunction, and family counseling.
Days 1–3 — Early Decision Phase: VISAGE scoring on days 1 and 3, multidisciplinary team review, early tracheostomy and PUG candidacy determination.
Days 3–5 — Procedure Window: Bedside percutaneous tracheostomy and PUG placement when clinically indicated. Ultrasound-guided approach and safety verification.
Days 5–14 — Early Recovery: Tube care and weaning initiation, swallow evaluation, early mobilization, and rehabilitation team engagement.
Days 14+ — Transition Planning: Decannulation readiness assessment, rehabilitation placement, and family education for long-term care.

VISAGE score ≥ threshold on Day 1 or Day 3 is required for early-intervention candidacy
Neurology, critical care, and surgery sign-off before bedside procedure
Ultrasound guidance mandatory for PUG placement
Respiratory therapy present for all tracheostomy procedures
Post-procedure CXR and tube-position confirmation documented