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NEuro icu

Emily L Zale, Tessa J Heinhuis, Tara Tehan, Danielle Salgueiro, Jonathan Rosand, Ana-Maria Vranceanu
OBJECTIVE: Every year, millions of Americans become informal caregivers to loved ones admitted to Neuroscience Intensive Care Units (Neuro-ICU), and face challenges to Quality of Life (QoL). This study sought to identify associations between resiliency, distress, and caregiver QoL at time of Neuro-ICU admission. METHODS: Informal caregivers (N = 79, Mage  = 53, 64% female) of Neuro-ICU patients were recruited and completed self-report questionnaires during the hospitalization...
March 6, 2018: General Hospital Psychiatry
Muhammad Waqas Khan, Susanne Muehlschlegel
Shared decision making is a collaborative decision-making process between health care providers and patients or their surrogates, taking into account the best scientific evidence available while considering the patient's values, goals, and preferences. Decision aids are tools enabling SDM. This article discusses shared decision making in general and in the intensive care unit in particular and facilitators and barriers for the creation and implementation of International Patient Decision Aids Standards Collaboration-compliant decision aids for the intensive care unit and neuro-intensive care unit...
April 2018: Neurosurgery Clinics of North America
Katharina Maria Busl
Infectious complications in the neurointensive care unit (neuro-ICU) are common, including pneumonia, urinary tract infection, bloodstream infection, and intracranial infection. The neuro-ICU population poses a specific challenge in the diagnosis of infections, because of the high incidence of fever in acutely brain-injured patients. Furthermore, susceptibility to infections is likely enhanced by brain-injury (induced immune modulation). This article reviews the concept of brain injury-induced immune modulation, and summarizes available data and knowledge on nosocomial meningitis and ventriculitis, and systemic infectious complications in patients with traumatic brain injury, ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and status epilepticus...
April 2018: Neurosurgery Clinics of North America
Martin Shaw, Laura Moss, Chris Hawthorne, John Kinsella, Ian Piper
OBJECTIVES: Raised intracranial pressure (ICP) is well known to be indicative of a poor outcome in traumatic brain injury (TBI). This phenomenon was quantified using a pressure time index (PTI) model of raised ICP burden in a paediatric population. Using the PTI methodology, this pilot study is aimed at investigating the relationship between raised ICP and length of stay (LOS) in adults admitted to a neurological intensive care unit (neuro-ICU). MATERIALS AND METHODS: In 10 patients admitted to the neuro-ICU following TBI, ICP was measured and data from the first 24 h were analysed...
2018: Acta Neurochirurgica. Supplement
Andrea Fanelli, Rohan Jaishankar, Aristotelis Filippidis, James Holsapple, Thomas Heldt
OBJECTIVES:  Our objective was to develop, deploy, and test a data-acquisition system for the reliable and robust archiving of high-resolution physiological waveform data from a variety of bedside monitoring devices, including the GE Solar 8000i patient monitor, and for the logging of ancillary clinical and demographic information. MATERIALS AND METHODS:  The data-acquisition system consists of a computer-based archiving unit and a GE Tram Rac 4A that connects to the GE Solar 8000i monitor...
2018: Acta Neurochirurgica. Supplement
Andrius Pranskunas, Tomas Tamosuitis, Neringa Balciuniene, Diana Damanskyte, Edvin Sneider, Astra Vitkauskiene, Edmundas Sirvinskas, Vidas Pilvinis, E Christiaan Boerma
As of now the relationship between glycocalyx degradation and microcirculatory perfusion abnormalities in non-septic critical ill patients is unclear. In addition, conjunctival sidestream dark field-imaging for the purpose of glycocalyx thickness estimation has never been performed. We aimed to investigate whether changes in glycocalyx thickness in non-septic patients are associated with microcirculatory alterations in conjunctival and sublingual mucosa. In this single-centre prospective observational study, using techniques for direct in-vivo observation of the microcirculation, we performed a single measurement of microcirculatory perfusion parameters and visualized glycocalyx thickness in both ocular conjunctiva and sublingual mucosa in mixed cardio surgical (n = 18) and neurocritical patients (n = 27) and compared these data with age-matched healthy controls (n = 20)...
February 17, 2018: Microvascular Research
Dnyaneshwar P Mutkule, S Manimala Rao, Jaydip Ray Chaudhuri, Kunche Rajasri
Status epilepticus is frequently encountered in neuro Intensive Care Units. It is a medical emergency and if not treated promptly can lead to severe brain damage and even death. Here, we present the case of a 18-year-old male with uncontrolled and unrelenting seizures with a rare etiology requiring ketamine infusion for burst suppression as it was resistant to thiopentone and midazolam infusions. The management of this case is presented in detail.
January 2018: Indian Journal of Critical Care Medicine
Delphine Georges, Hugues de Courson, Romain Lanchon, Musa Sesay, Karine Nouette-Gaulain, Matthieu Biais
BACKGROUND: In mechanically ventilated patients, an increase in cardiac index during an end-expiratory-occlusion test predicts fluid responsiveness. To identify this rapid increase in cardiac index, continuous and instantaneous cardiac index monitoring is necessary, decreasing its feasibility at the bedside. Our study was designed to investigate whether changes in velocity time integral and in peak velocity obtained using transthoracic echocardiography during an end-expiratory-occlusion maneuver could predict fluid responsiveness...
February 8, 2018: Critical Care: the Official Journal of the Critical Care Forum
Ivan Savin, Ksenia Ershova, Nataliya Kurdyumova, Olga Ershova, Oleg Khomenko, Gleb Danilov, Michael Shifrin, Vladimir Zelman
PURPOSE: To define the incidence of healthcare-associated ventriculitis and meningitis (HAVM) in the neuro-ICU and to identify HAVM risk factors using tree-based machine learning (ML) algorithms. METHODS: An observational cohort study was conducted in Russia from 2010 to 2017, and included high-risk neuro-ICU patients. We utilized relative risk analysis, regressions, and ML to identify factors associated with HAVM development. RESULTS: 2286 patients of all ages were included, 216 of them had HAVM...
February 5, 2018: Journal of Critical Care
Yasser B Abulhasan, Najayeb Alabdulraheem, Gabrielle Simoneau, Mark R Angle, Jeanne Teitelbaum
OBJECTIVE: To evaluate primary causes of death after spontaneous subarachnoid hemorrhage (SAH) and externally validate the HAIR score, a prognostication tool, in a single academic institution. METHODS: We reviewed all SAH patients admitted to our Neuro-ICU between 2010 and 2016. Univariate and multivariate logistic regressions were performed to identify predictors of in-hospital mortality. The HAIR score predictors were Hunt and Hess grade at treatment decision, age, intraventricular hemorrhage, and re-bleeding within 24 hours...
January 31, 2018: World Neurosurgery
Miran Goo, Kylie Tucker, Leanne M Johnston
AIM: The aim of this study was to identify and examine the psychometric properties of muscle tone assessments for children aged 0 to 12 years. METHOD: Four electronic databases were searched to identify studies that included assessments of resting and/or active muscle tone. Methodological quality and overall psychometric evidence of studies were rated using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. RESULTS: Twenty-one assessments were identified from 97 included studies...
February 6, 2018: Developmental Medicine and Child Neurology
Yasser B Abulhasan, Susan P Rachel, Marc-Olivier Châtillon-Angle, Najayeb Alabdulraheem, Ian Schiller, Nandini Dendukuri, Mark R Angle, Charles Frenette
BACKGROUND: Healthcare-associated infections (HAIs) occur frequently in neurological intensive care units (neuro-ICUs); however, data differentiating associations with various diagnostic categories and resulting burdens are limited. This prospective cohort study reported incidence rates, pathogen distribution, and patient-related outcomes of HAIs in a neuro-ICU population from April 2010 to March 2016. METHODS: Laboratory results and specific clinical indicators were used to categorize infections as per National Healthcare Safety Network nosocomial infection surveillance definitions...
January 25, 2018: American Journal of Infection Control
Lisa Manente, Terri McCluskey, Rachel Shaw
Transitioning patients from one unit to another is a nursing function that occurs daily. When done effectively, it streamlines continuity of care, decreases anxiety, ensures patients and families maintain confidence in care providers, and avoids readmissions to the intensive care unit (ICU). This article describes a transition plan for transferring patients from the ICU to the general pediatric unit developed by an inpatient, non-critical care cardiology/neuro logical unit to facilitate a smooth and informational transition from the ICU to the non-critical unit...
March 2017: Pediatric Nursing
Mohamad Hasyizan Hassan, Wan Mohd Nazaruddin Wan Hassan, Rhendra Hardy Mohd Zaini, Wan Fadzlina Wan Muhd Shukeri, Huda Zainal Abidin, Chong Soon Eu
Background: Normal saline (NS) is a common fluid of choice in neurosurgery and neuro-intensive care unit (ICU), but it does not contain other electrolytes and has the potential to cause hyperchloremic metabolic acidosis with prolonged infusion. These problems may be reduced with the availability of balanced fluid (BF), which becomes a more physiological isotonic solution with the presence of complete electrolyte content. This study aimed to compare the changes in electrolytes and acid-base between NS and BF (Sterofundin® ISO) therapy for post-operative severe traumatic brain injury (TBI) patients in neuro-ICU...
October 2017: Malaysian Journal of Medical Sciences: MJMS
Rafael Badenes, Chiara Robba, Fabio S Taccone, Federico Bilotta
PURPOSE OF REVIEW: This article revises the recent evidence on ICU admission criteria for acute neurological patients [traumatic brain injury (TBI) patients, postoperative neurosurgical procedures and stroke]. RECENT FINDINGS: The appropriate utilization of ICU beds is essential, but it is complex and a challenge to attain. To date there are no widely accepted international guidelines for managing these acute brain-injured patients (stroke, TBI, postneurosurgery) in the ICU...
April 2018: Current Opinion in Critical Care
R Muthuchellappan, N A Shaikh, R M Surve, U R S Ganne, M Philip
BACKGROUND: Although central venous oxygen saturation (ScvO2 ) is used to decide on red blood cell (RBC) transfusion, whether its improvement is associated with parallel improvement in cerebral oxygenation is not adequately studied. This study looked at changes in regional cerebral tissue oxygen saturation (rSO2 ) following RBC transfusion in neuro-intensive care unit (ICU) patients. METHODS: In this prospective observational pilot study, rSO2 was measured in adult neuro-ICU patients before RBC transfusion, at the end and at 6, 12, 18 and 24 h after RBC transfusion...
January 10, 2018: Transfusion Medicine
Antara Gokhale, Atheel Kimona, Sandeep Kantor, S Prakash, Yogesh Manhas
Introduction: Posterior reversible encephalopathy syndrome (PRES) is characterized by a range of clinico neuro radiological manifestation along with hypertension due to varied etiology. Contrary to its name, a small number of patients have residual neurological deficits. Patients with severe manifestation of PRES may get admitted to the Intensive Care Unit (ICU) due to coma or status epilepticus. Small case series and large multicenter studies have been reported. Materials and Methods: We report a single center series of ten cases admitted to ICU over a 5 year period in a tertiary care centre...
November 2017: Indian Journal of Critical Care Medicine
Livio Provenzi, Giunia Scotto di Minico, Roberto Giorda, Rosario Montirosso
Preterm infants present an immature neurobehavioral profile at birth, even in absence of severe brain injuries and perinatal complications. As such, they require a long-lasting hospitalization in the Neonatal Intensive Care Unit (NICU), which is thought to grant at-risk newborns' survival, but still entails a number of physical, painful, and socio-emotional stressors. Hence, preterm birth and NICU stay represent an early adverse experience, which has been linked to detrimental consequences for neurological, neuro-endocrinal, behavioral, and socio-emotional development, as well as to disease later in life...
2017: Frontiers in Endocrinology
Brian J Yun, Pierre Borczuk, Lulu Wang, Stephen Dorner, Benjamin A White, Ali S Raja
OBJECTIVES: Among emergency physicians, there is wide variation in admitting practices for patients who suffered a mild traumatic brain injury (TBI) with an intracranial hemorrhage (ICH). The purpose of this study was to evaluate the effects of implementing a protocol in the emergency department (ED) observation unit for patients with mild TBI and ICH. METHODS: This retrospective cohort study was approved by the institutional review board. Study subjects were patients ≥ 18 years of age with an International Classification of Diseases code corresponding to a traumatic ICH and admitted to an ED observation unit (EDOU) of an urban, academic Level I trauma center between February 1, 2015, and January 31, 2017...
November 20, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Stefano Spina, Chiara Marzorati, Alessia Vargiolu, Federico Magni, Matteo Riva, Matteo Rota, Carlo Giussani, Erik P Sganzerla, Giuseppe Citerio
BACKGROUND: Intracerebral hemorrhage (ICH) admitted to intensive care is deem of poor prognosis. To compare observed and predicted 30-days mortality and to evaluate long term functional outcome in a consecutive ICH cohort. METHODS: Retrospective analysis of prospectively collected data of ICH patients managed in a Neuro-ICU from 2012 to 2015. RESULTS: 136 consecutive patients; 34 (25%) had "withholding of life-sustaining treatment" (WLST) order and 102 (75%) received a "full treatment" (FT)...
November 6, 2017: Minerva Anestesiologica
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