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https://www.readbyqxmd.com/read/28980699/mobilization-in-early-rehabilitation-in-intensive-care-unit-patients-with-severe-acquired-cerebral-injury-an-observational-study
#1
Michelangelo Bartolo, Stefano Bargellesi, Carlo Alberto Castioni, Domenico Intiso, Andrea Fontana, Massimiliano Copetti, Federico Scarponi, Donatella Bonaiuti
OBJECTIVE: To determine whether early mobilization of patients with severe acquired brain injury, performed in the intensive/neurointensive care unit, influences functional outcome. DESIGN: Prospective observational study. SETTING: Fourteen centres in Italy. SUBJECTS: A total of 103 consecutive patients with acquired brain injury. METHODS: Clinical, neurological and functional data, including the Glasgow Coma Scale (GCS), Disability Rating Scale (DRS), the Rancho Los Amigos Levels of Cognitive Functioning (LCF), Early Rehabilitation Barthel Index (ERBI), Glasgow Outcome Scale (GOS), and Functional Independence Measure (FIM) were collected at admission and every 3?5 days until discharge from the intensive/neurointensive care unit...
October 5, 2017: Journal of Rehabilitation Medicine
https://www.readbyqxmd.com/read/28962814/nosocomial-infections-in-the-neurointensive-care-unit
#2
REVIEW
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...
November 2017: Neurologic Clinics
https://www.readbyqxmd.com/read/28936494/detection-of-intracranial-hypertension-using-deep-learning
#3
Benjamin Quachtran, Robert Hamilton, Fabien Scalzo
Intracranial Hypertension, a disorder characterized by elevated pressure in the brain, is typically monitored in neurointensive care and diagnosed only after elevation has occurred. This reaction-based method of treatment leaves patients at higher risk of additional complications in case of misdetection. The detection of intracranial hypertension has been the subject of many recent studies in an attempt to accurately characterize the causes of hypertension, specifically examining waveform morphology. We investigate the use of Deep Learning, a hierarchical form of machine learning, to model the relationship between hypertension and waveform morphology, giving us the ability to accurately detect presence hypertension...
December 2016: Proceedings of the ... IAPR International Conference on Pattern Recognition
https://www.readbyqxmd.com/read/28929392/preventing-early-bouncebacks-to-the-neurointensive-care-unit-a-retrospective-analysis-and-quality-improvement-pilot
#4
David G Coughlin, Monisha A Kumar, Neha N Patel, Rebecca L Hoffman, Scott E Kasner
BACKGROUND: Early unplanned readmissions of "bouncebacks" to intensive care units are a healthcare quality metric and result in higher mortality and greater cost. Few studies have examined bouncebacks to the neurointensive care unit (neuro-ICU), and we sought to design and implement a quality improvement pilot to reduce that rate. METHODS: First, we performed a retrospective chart review of 504 transfers to identify potential bounceback risk factors. Risk factors were assessed on the day of transfer by the transferring physician identifying patients as "high risk" or "low risk" for bounceback...
September 19, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28904572/outcome-predictors-in-pediatric-head-trauma-a-study-of-clinicoradiological-factors
#5
Kanwaljeet Garg, Ravi Sharma, Deepak Gupta, Sumit Sinha, Guru Dutt Satyarthee, Deepak Agarwal, Shashank Sarad Kale, Bhawani Shankar Sharma, Ashok Kumar Mahapatra
INTRODUCTION: Traumatic injuries are the leading cause of death and a major cause of disability among children. About 70%-80% of the accidental deaths in pediatric age group result directly from central nervous system lesions. METHODS: The purpose of our study was to study all the patients of ≤18 years of age with head or spinal injury admitted in neurointensive care unit at our center, an apex trauma center in a developing country, between June 2009 and September 2011...
April 2017: Journal of Pediatric Neurosciences
https://www.readbyqxmd.com/read/28885463/author-response-implementation-of-an-early-mobility-pathway-in-neurointensive-care-unit-patients-with-ventriculostomies
#6
Megan T Moyer
No abstract text is available yet for this article.
October 2017: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/28790967/rethinking-neuroprotection-in-severe-traumatic-brain-injury-toward-bedside-neuroprotection
#7
REVIEW
Tommaso Zoerle, Marco Carbonara, Elisa R Zanier, Fabrizio Ortolano, Giulio Bertani, Sandra Magnoni, Nino Stocchetti
Neuroprotection after traumatic brain injury (TBI) is an important goal pursued strenuously in the last 30 years. The acute cerebral injury triggers a cascade of biochemical events that may worsen the integrity, function, and connectivity of the brain cells and decrease the chance of functional recovery. A number of molecules acting against this deleterious cascade have been tested in the experimental setting, often with preliminary encouraging results. Unfortunately, clinical trials using those candidate neuroprotectants molecules have consistently produced disappointing results, highlighting the necessity of improving the research standards...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28742869/ultrasound-non-invasive-measurement-of-intracranial-pressure-in-neurointensive-care-a-prospective-observational-study
#8
COMPARATIVE STUDY
Chiara Robba, Danilo Cardim, Tamara Tajsic, Justine Pietersen, Michael Bulman, Joseph Donnelly, Andrea Lavinio, Arun Gupta, David K Menon, Peter J A Hutchinson, Marek Czosnyka
BACKGROUND: The invasive nature of the current methods for monitoring of intracranial pressure (ICP) has prevented their use in many clinical situations. Several attempts have been made to develop methods to monitor ICP non-invasively. The aim of this study is to assess the relationship between ultrasound-based non-invasive ICP (nICP) and invasive ICP measurement in neurocritical care patients. METHODS AND FINDINGS: This was a prospective, single-cohort observational study of patients admitted to a tertiary neurocritical care unit...
July 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28733841/analgosedation-of-adult-patients-with-elevated-intracranial-pressure-survey-of-current-clinical-practice-in-austria
#9
Guenther Herzer, Claudia Mirth, Udo M Illievich, Wolfgang G Voelckel, Helmut Trimmel
BACKGROUND: Analgesia and sedation are key items in intensive care. Recently published S3 guidelines specifically address treatment of patients with elevated intracranial pressure. METHODS: The Austrian Society of Anesthesiology, Resuscitation and Intensive Care Medicine carried out an online survey of neurointensive care units in Austria in order to evaluate the current state of practice in the areas of analgosedation and delirium management in this high-risk patient group...
July 21, 2017: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/28685395/what-families-need-and-physicians-deliver-contrasting-communication-preferences-between-surrogate-decision-makers-and-physicians-during-outcome-prognostication-in-critically-ill-tbi-patients
#10
Thomas Quinn, Jesse Moskowitz, Muhammad W Khan, Lori Shutter, Robert Goldberg, Nananda Col, Kathleen M Mazor, Susanne Muehlschlegel
BACKGROUND: Surrogate decision-makers ("surrogates") and physicians of incapacitated patients have different views of prognosis and how it should be communicated, but this has not been investigated in neurocritically ill patients. We examined surrogates' communication preferences and physicians' practices during the outcome prognostication for critically ill traumatic brain injury (ciTBI) patients in two level-1 trauma centers and seven academic medical centers in the USA. METHODS: We used qualitative content analysis and descriptive statistics of transcribed interviews to identify themes in surrogates (n = 16) and physicians (n = 20)...
July 6, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28685393/side-effects-of-long-term-continuous-intra-arterial-nimodipine-infusion-in-patients-with-severe-refractory-cerebral-vasospasm-after-subarachnoid-hemorrhage
#11
Martin Kieninger, Julia Flessa, Nicole Lindenberg, Sylvia Bele, Andreas Redel, André Schneiker, Gerhard Schuierer, Christina Wendl, Bernhard Graf, Vera Silbereisen
BACKGROUND: Long-term continuous intra-arterial nimodipine infusion (CIAN) is a rescue therapy option in cases of severe refractory cerebral vasospasm (CV) following acute non-traumatic subarachnoid hemorrhage (SAH). However, CIAN therapy can be associated with relevant side effects. Available studies focus on intracerebral complications, whereas extracerebral side effects are rarely examined. Aim of the present study was to generate descriptive data on the clinical course during CIAN therapy and expectable extracerebral side effects...
July 6, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28639000/infections-in-neurocritical-care
#12
John C O'Horo, Priya Sampathkumar
Neurointensive care (NICU) patients experience complex infectious disease challenges. Central nervous system (CNS) infections are difficult to diagnose and treat, and post-neurosurgical patients are vulnerable to a unique set of healthcare-acquired infections (HAI) in addition to those typical of critically ill patients. The purpose of this review is to summarize the approach to suspected infection in the NICU and discuss management of several infectious syndromes in the NICU setting.
June 21, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28594285/cognitive-event-related-potentials-during-the-sub-acute-phase-of-severe-traumatic-brain-injury-and-their-relationship-to-outcome
#13
Solveig L Hauger, Kjell Olafsen, Caroline Schnakers, Nada Andelic, Kristian Bernhard Nilsen, Eirik Helseth, Ingrid Funderud, Stein Andersson, Anne-Kristine Schanke, Marianne Løvstad
Predicting outcome in the early phase after severe traumatic brain injury (sTBI) is a major clinical challenge, particularly identifying patients with potential for good cognitive outcome. The current single-center prospective study aimed to explore presence and normalization of electroencephalography (EEG)-based event-related potentials (ERPs) in the early phase followings TBI, and their relationship to functional and cognitive outcome 6 months post-injury. Fourteen adult patients (eight males) with sTBI were recruited from the neurointensive care unit (mean age = 38...
August 7, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28497668/potential-brain-dead-organ-donation-in-neurocritical-care-mortality
#14
Vera Spatenkova, Ondrej Bradac, Petr Suchomel
BACKGROUND: Mortality is a marker of quality in neurocritical care, but it also provides potential for donors after brain death (DBD) following irreversible acute brain damage. The aim of this study was to analyse the neurointensive care unit (NICU) mortality rate and recovery of potential DBD. METHODS: We performed a 10-year prospective observational cohort computer database analysis of 6138 acute neurological and neurosurgical patients (pts, 58.2% male, mean: age 55...
May 11, 2017: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/28490277/interleukin-33-promotes-recruitment-of-microglia-macrophages-in-response-to-traumatic-brain-injury
#15
Grzegorz Wicher, Ulrika Wallenquist, Ying Lei, Mattias Enoksson, Xiaofei Li, Barbara Fuchs, Sami Abu Hamdeh, Niklas Marklund, Lars Hillered, Gunnar Nilsson, Karin Forsberg-Nilsson
Traumatic brain injury (TBI) is a devastating condition, often leading to life-long consequences for patients. Even though modern neurointensive care has improved functional and cognitive outcomes, efficient pharmacological therapies are still lacking. Targeting peripherally derived, or resident inflammatory, cells that are rapid responders to brain injury is promising, but complex, given that the contribution of inflammation to exacerbation versus improved recovery varies with time post-injury. The injury-induced inflammatory response is triggered by release of alarmins, and in the present study we asked whether interleukin-33 (IL-33), an injury-associated nuclear alarmin, is involved in TBI...
July 21, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28463046/the-influence-of-hyperthermia-on-intracranial-pressure-cerebral-oximetry-and-cerebral-metabolism-in-traumatic-brain-injury
#16
Lena Nyholm, Tim Howells, Anders Lewén, Lars Hillered, Per Enblad
BACKGROUND: Hyperthermia is a common secondary insult in traumatic brain injury (TBI). The aim was to evaluate the relationship between hyperthermia and intracranial pressure (ICP), and if intracranial compliance and cerebral blood flow (CBF) pressure autoregulation affected that relationship. The relationships between hyperthermia and cerebral oximetry (BtipO2) and cerebral metabolism were also studied. METHODS: A computerized multimodality monitoring system was used for data collection at the neurointensive care unit...
May 2, 2017: Upsala Journal of Medical Sciences
https://www.readbyqxmd.com/read/28447929/five-year-follow-up-on-transplanted-organs-from-donors-after-brain-death-after-acute-stroke
#17
Vera Spatenkova, Eva Pokorna, Petr Suchomel
OBJECTIVES: Efficient intensive care donor management can help alleviate the shortage of organs for transplant. The aim of this study was to investigate the efficiency of management of donors after brain death from our neurointensive care unit. MATERIALS AND METHODS: We conducted a prospective observational 5-year follow-up on 29 transplanted organs from 14 brain-dead donors after acute stroke (7 subarachnoid and 4 intracerebral hemorrhages, 3 ischemic strokes)...
April 27, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28443389/neuroscience-intermediate-level-care-units-staffed-by-intensivists-clinical-outcomes-and-cost-analysis
#18
Kwadwo Kyeremanteng, Ariel Hendin, Kalpana Bhardwaj, Kednapa Thavorn, Dave Neilipovitz, Dalibour Kubelik, Gianni D'Egidio, Grant Stotts, Erin Rosenberg
INTRODUCTION: With an aging population and increasing numbers of intensive care unit admissions, novel ways of providing quality care at reduced cost are required. Closed neurointensive care units improve outcomes for patients with critical neurological conditions, including decreased mortality and length of stay (LOS). Small studies have demonstrated the safety of intermediate-level units for selected patient populations. However, few studies analyze both cost and safety outcomes of these units...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28419731/a-qualitative-study-of-doctors-and-nurses-barriers-to-communicating-with-seriously-ill-patients-about-their-dependent-children
#19
Annemarie Dencker, Bo Andreassen Rix, Per Bøge, Tine Tjørnhøj-Thomsen
OBJECTIVE: Research indicates that health personnel (HP) caring for seriously ill patients with dependent children aged 0-18 often avoid discussing with them the challenges of being a family with a parent in treatment. Children of seriously ill patients (CSIP) risk serious trauma and emotional difficulty later in life and depend on adult support to minimize these consequences. Patients suffer anxiety about supporting their children during their illness. Due to their potentially pivotal role in supporting patients in enabling parent-child communication, we examined HP's structural and emotional barriers to communicating with patients about their children...
April 18, 2017: Psycho-oncology
https://www.readbyqxmd.com/read/28400902/a-novel-neuroscience-intermediate-level-care-unit-model-retrospective-analysis-of-impact-on-patient-flow-and-safety
#20
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
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