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Neurocritical care

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https://www.readbyqxmd.com/read/28437224/structure-process-and-culture-of-intensive-care-units-treating-patients-with-severe-traumatic-brain-injury-survey-of-centers-participating-in-the-american-college-of-surgeons-trauma-quality-improvement-program
#1
Aziz S Alali, Victroia McCredie, Todd G Mainprize, David Gomez, Avery B Nathens
Outcome after severe traumatic brain injury (TBI) differs substantially between hospitals. Explaining this variation begins with understanding the differences in structures and processes of care, particularly at intensive care units (ICUs) where acute TBI care takes place. We invited trauma medical directors (TMDs) from 187 centers participating in the American College of Surgeons Trauma Quality Improvement Program to complete a survey. The survey domains included ICU model, type, availability of specialized units, staff, training programs, standard protocols and order sets, approach to withdrawal of life support, and perceived level of neurosurgeons' engagement in the ICU management of TBI...
February 15, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28421189/optic-nerve-sheath-diameter-ultrasound-evaluation-in-intensive-care-unit-possible-role-and-clinical-aspects-in-neurological-critical-patients-daily-monitoring
#2
M Toscano, G Spadetta, P Pulitano, M Rocco, V Di Piero, O Mecarelli, E Vicenzini
Background. The increase of the optic nerve sheath diameter (ONSD) is a reliable, noninvasive sonographic marker of intracranial hypertension. Aim of the study was to demonstrate the efficacy of ONSD evaluation, when monitoring neurocritical patients, to early identify malignant intracranial hypertension in patients with brain death (BD). Methods. Data from ultrasound ONSD evaluation have been retrospectively analyzed in 21 sedated critical patients with neurological diseases who, during their clinical course, developed BD...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28400902/a-novel-neuroscience-intermediate-level-care-unit-model-retrospective-analysis-of-impact-on-patient-flow-and-safety
#3
Alexandra E Quimby, Michel C F Shamy, Deanna M Rothwell, Erin Y Liu, Dar Dowlatshahi, Grant Stotts
BACKGROUND AND PURPOSE: Neurointensive care units have been shown to improve patient outcomes across a variety of neurological and neurosurgical conditions. However, the efficacy of less resource-intensive intermediate-level care units to deliver similar care has not been well studied. The purpose of this study is to evaluate the impact of neurocritical specialist comanagement on patient flow and safety in a neuroscience intermediate-level care unit. METHODS: Our intervention consisted of the addition of a physician with critical care experience as well as training in neurology, anesthesiology, or intensive care to a neuroscience intermediate-level care unit to comanage patients alongside neurology and neurosurgery staff during weekday daytime hours...
April 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28385926/critical-care-air-transport-team-severe-traumatic-brain-injury-short-term-outcomes-during-flight-for-operation-iraqi-freedom-operation-enduring-freedom
#4
L Renee Boyd, J Borawski, J Lairet, A T Limkakeng
INTRODUCTION: Our understanding of the expertise and equipment required to air transport injured soldiers with severe traumatic brain injuries (TBIs) continue to evolve. METHODS: We conducted a retrospective chart review of characteristics, interventions required and short-term outcomes of patients with severe TBI managed by the US Air Force Critical Care Air Transport Teams (CCATTs) deployed in support of Operation Iraqi Freedom and Operation Enduring Freedom between 1 June 2007 and 31 August 2010...
April 6, 2017: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/28365631/management-of-acute-intracerebral-haemorrhage-an%C3%A2-update
#5
Zhe Kang Law, Jason P Appleton, Philip M Bath, Nikola Sprigg
Managing acute intracerebral haemorrhage is a challenging task for physicians. Evidence shows that outcome can be improved with admission to an acute stroke unit and active care, including urgent reversal of anticoagulant effects and, potentially, intensive blood pressure reduction. Nevertheless, many management issues remain controversial, including the use of haemostatic therapy, selection of patients for neurosurgery and neurocritical care, the extent of investigations for underlying causes and the benefit versus risk of restarting antithrombotic therapy after an episode of intracerebral haemorrhage...
April 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28362667/implementation-strategies-in-pediatric-neurocritical-care
#6
Christopher Markham, Enola K Proctor, Jose A Pineda
PURPOSE OF REVIEW: Brain-directed critical care for children is a relatively new area of subspecialization in pediatric critical care. Pediatric neurocritical care teams combine the expertise of neurology, neurosurgery, and critical care medicine. The positive impact of delivering specialized care to pediatric patients with acute neurological illness is becoming more apparent, but the optimum way to implement and sustain the delivery of this is complicated and poorly understood. We aim to provide emerging evidence supporting that effective implementation of pediatric neurocritical care pathways can improve patient survival and outcomes...
March 30, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28343456/implementation-of-neurocritical-care-is-associated-with-improved-outcomes-in-traumatic-brain-injury
#7
Mypinder S Sekhon, Peter Gooderham, Brian Toyota, Navid Kherzi, Vivien Hu, Vinay K Dhingra, Morad S Hameed, Dean R Chittock, Donald E Griesdale
Background Traditionally, the delivery of dedicated neurocritical care (NCC) occurs in distinct NCC units and is associated with improved outcomes. Institution-specific logistical challenges pose barriers to the development of distinct NCC units; therefore, we developed a consultancy NCC service coupled with the implementation of invasive multimodal neuromonitoring, within a medical-surgical intensive care unit. Our objective was to evaluate the effect of a consultancy NCC program on neurologic outcomes in severe traumatic brain injury patients...
March 27, 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/28340494/postoperative-care-of-patients-with-high-grade-glioma-is-there-a-real-need-for-the-neurocritical-icu-and-early-ct-scan
#8
Roberto Altieri, Fabio Cofano, Alessandro Agnoletti, Riccardo Fornaro, Marco Ajello, Francesco Zenga, Alessandro Ducati, Diego Garbossa
Background Pressure on economic resources now requires a careful rationalization of services. For adult patients with supratentorial gliomas, there is no consensus on the real need for care in a postoperative neurocritical intensive care unit (NICU) and on the timing of a postsurgical computed tomography (CT) scan. In this retrospective nonrandomized study, we assessed if and when there is a real need for NICU and if an early CT scan could be justified in the absence of neurologic worsening. Methods Of 264 patients, 21 were admitted to the NICU after the procedure as planned before the surgery for their clinical features (Karnofsky performance status < 70, American Society of Anesthesiologists score > 2, or Charlson Comorbidity Index > 5)...
March 24, 2017: Journal of Neurological Surgery. Part A, Central European Neurosurgery
https://www.readbyqxmd.com/read/28330412/early-asymmetric-cardio-cerebral-causality-and-outcome-after-severe-traumatic-brain-injury
#9
Lei Gao, Peter Smieleweski, Marek Czosnyka, Ari Ercole
The brain and heart are two vital systems in health and disease, increasingly recognised as a complex, interdependent network with constant information flow in both directions. After severe traumatic brain injury (TBI), the causal, directed interactions between the brain, heart and autonomic nervous system have not been well established. Novel methods are needed to probe unmeasured, potentially prognostic information in complex biological networks that are not revealed via traditional means. In this study, we examined potential bi-directional causality between intracranial pressure (ICP), mean arterial pressure (MAP) and heart rate (HR) and its relationship to mortality in a 24-hour period early after TBI...
March 23, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28328648/the-economic-and-clinical-impact-of-sustained-use-of-a-progressive-mobility-program-in-a-neuro-icu
#10
Jeannette M Hester, Peggy R Guin, Gale D Danek, Jaime R Thomas, William L Titsworth, Richard K Reed, Terrie Vasilopoulos, Brenda G Fahy
OBJECTIVE: To investigate a progressive mobility program in a neurocritical care population with the hypothesis that the benefits and outcomes of the program (e.g., decreased length of stay) would have a significant positive economic impact. DESIGN: Retrospective analysis of economic and clinical outcome data before, immediately following, and 2 years after implementation of the Progressive Upright Mobility Protocol Plus program (UF Health Shands Hospital, Gainesville, FL) involving a series of planned movements in a sequential manner with an additional six levels of rehabilitation in the neuro-ICU at UF Health Shands Hospital...
March 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28325463/perioperative-management-of-anticoagulation
#11
REVIEW
Daipayan Guha, R Loch Macdonald
Antiplatelet and anticoagulant drugs (antithrombotics) predispose to acute and chronic subdural hematomas. Patients on these drugs are at higher likelihood of presenting with larger hematomas and more severe neurologic deficits. Standard neurosurgical and neurocritical care of subdural hematomas involves reversal of antithrombosis preoperatively, whereas reversing antiplatelet drugs is less clear. This article highlights the spectrum of antithrombotic agents in common use, their mechanisms of action, and strategies for reversal...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325461/neurocritical-care-of-acute-subdural-hemorrhage
#12
REVIEW
Fawaz Al-Mufti, Stephan A Mayer
Although urgent surgical hematoma evacuation is necessary for most patients with subdural hematoma (SDH), well-orchestrated, evidenced-based, multidisciplinary, postoperative critical care is essential to achieve the best possible outcome. Acute SDH complicates approximately 11% of mild to moderate traumatic brain injuries (TBIs) that require hospitalization, and approximately 20% of severe TBIs. Acute SDH usually is related to a clear traumatic event, but in some cases can occur spontaneously. Management of SDH in the setting of TBI typically conforms to the Advanced Trauma Life Support protocol with airway taking priority, and management breathing and circulation occurring in parallel rather than sequence...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28319562/translating-biomarkers-from-research-to-clinical-use-in-pediatric-neurocritical-care-focus-on-traumatic-brain-injury-and-cardiac-arrest
#13
Andrew J Prout, Michael S Wolf, Ericka L Fink
PURPOSE OF REVIEW: Traumatic brain injury (TBI) and cardiac arrest are important causes of morbidity and mortality in children. Improved diagnosis and outcome prognostication using validated biomarkers could allow clinicians to better tailor therapies for optimal efficacy. RECENT FINDINGS: Contemporary investigation has yielded plentiful biomarker candidates of central nervous system (CNS) injury, including macromolecules, genetic, inflammatory, oxidative, and metabolic biomarkers...
March 17, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28295447/effectiveness-and-tolerability-of-conivaptan-and-tolvaptan-for-the-treatment-of-hyponatremia-in-neurocritically-ill-patients
#14
Caroline Der-Nigoghossian, Christine Lesch, Karen Berger
STUDY OBJECTIVE: To describe the effectiveness and tolerability of conivaptan and tolvaptan for the correction of hyponatremia in neurocritically ill patients. DESIGN: Retrospective cohort study. SETTING: Neurointensive care units at two academic medical centers. PATIENTS: Thirty-six adults admitted to the neurocritical care unit who received at least one dose of conivaptan (5 patients) or tolvaptan (31 patients) between June 2012 and May 2013...
March 12, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28282628/blood-transfusion-indications-in-neurosurgical-patients-a-systematic-review
#15
REVIEW
Shefali Bagwe, Lawrance K Chung, Carlito Lagman, Brittany L Voth, Natalie E Barnette, Lekaa Elhajjmoussa, Isaac Yang
Neurosurgical procedures can be complicated by significant blood losses that have the potential to decrease tissue perfusion to critical brain tissue. Red blood cell transfusion is used in a variety of capacities both inside, and outside, of the operating room to prevent untoward neurologic damage. However, evidence-based guidelines concerning thresholds and indications for transfusion in neurosurgery remain limited. Consequently, transfusion practices in neurosurgical patients are highly variable and based on institutional experiences...
April 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28241749/development-and-validation-of-a-score-for-evaluating-comprehensive-stroke-care-capabilities-j-aspect-study
#16
Akiko Kada, Kunihiro Nishimura, Jyoji Nakagawara, Kuniaki Ogasawara, Junichi Ono, Yoshiaki Shiokawa, Toru Aruga, Shigeru Miyachi, Izumi Nagata, Kazunori Toyoda, Shinya Matsuda, Akifumi Suzuki, Hiroharu Kataoka, Fumiaki Nakamura, Satoru Kamitani, Koji Iihara
BACKGROUND: Although the Brain Attack Coalition recommended establishing centers of comprehensive care for stroke and cerebrovascular disease patients, a scoring system for such centers was lacking. We created and validated a comprehensive stroke center (CSC) score, adapted to Japanese circumstances. METHODS: Of the selected 1369 certified training institutions in Japan, 749 completed an acute stroke care capabilities survey. Hospital performance was determined using a 25-item score, evaluating 5 subcategories: personnel, diagnostic techniques, specific expertise, infrastructure, and education...
February 28, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28239054/critical-care-management-focused-on-optimizing-brain-function-after-cardiac-arrest
#17
REVIEW
Ryuta Nakashima, Toru Hifumi, Kenya Kawakita, Tomoya Okazaki, Satoshi Egawa, Akihiko Inoue, Ryutaro Seo, Nobuhiro Inagaki, Yasuhiro Kuroda
The discussion of neurocritical care management in post-cardiac arrest syndrome (PCAS) has generally focused on target values used for targeted temperature management (TTM). There has been less attention paid to target values for systemic and cerebral parameters to minimize secondary brain damage in PCAS. And the neurologic indications for TTM to produce a favorable neurologic outcome remain to be determined. Critical care management of PCAS patients is fundamental and essential for both cardiologists and general intensivists to improve neurologic outcome, because definitive therapy of PCAS includes both special management of the cause of cardiac arrest, such as coronary intervention to ischemic heart disease, and intensive management of the results of cardiac arrest, such as ventilation strategies to avoid brain ischemia...
March 24, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28225527/neuro-trauma-or-med-surg-intensive-care-unit-does-it-matter-where-multiple-injuries-patients-with-traumatic-brain-injury-are-admitted-secondary-analysis-of-the-american-association-for-the-surgery-of-trauma-multi-institutional-trials-committee-decompressive
#18
Sarah Lombardo, Thomas Scalea, Jason Sperry, Raul Coimbra, Gary Vercruysse, Toby Enniss, Gregory J Jurkovich, Raminder Nirula
INTRODUCTION: Patients with nontraumatic acute intracranial pathology benefit from neurointensivist care. Similarly, trauma patients with and without traumatic brain injury (TBI) fare better when treated by a dedicated trauma team. No study has yet evaluated the role of specialized neurocritical (NICU) and trauma intensive care units (TICU) in the management of TBI patients, and it remains unclear which TBI patients are best served in NICU, TICU, or general (Med/Surg) ICU. METHODS: This study is a secondary analysis of The American Association for the Surgery of Trauma Multi-Institutional Trials Committee (AAST-MITC) decompressive craniectomy study...
March 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28222319/survey-of-the-diagnostic-and-therapeutic-approach-to-new-onset-refractory-status-epilepticus
#19
Christian M Cabrera Kang, Nicolas Gaspard, Suzette M LaRoche, Brandon Foreman
PURPOSE: We conducted a survey of providers to assess for practice patterns in diagnosing and treating new-onset refractory status epilepticus (NORSE). NORSE is the occurrence of prolonged seizures that are not responsive to initial therapies in otherwise healthy individuals without obvious cause on initial presentation. This entity is thought to have multiple etiologies, including autoimmune. METHOD: A 29-question electronic survey was sent to providers included in the Neurocritical Care Society emailing list...
March 2017: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/28209460/pharmacologic-cardioversion-with-intravenous-amiodarone-is-likely-safe-in-neurocritically-ill-patients
#20
Michael Su, David Seki, Asma M Moheet
Neurological injury is often associated with cardiac abnormalities, including electrophysiological issues. Cardioversion of acute atrial fibrillation (<48h' duration) without anticoagulation carries about a 0.7% risk of thromboembolism. There is limited data on managing acute atrial fibrillation specifically in the neuroscience intensive care unit (NSICU) setting. We sought to determine the safety of using intravenous (IV) amiodarone for restoring sinus rhythm in patients with presumed new onset atrial or ventricular tachycardia after neurological injury...
February 13, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
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