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https://www.readbyqxmd.com/read/29119023/improvement-in-quality-metrics-outcomes-and-patient-and-family-satisfaction-in-a-neurosciences-intensive-care-unit-after-creation-of-a-dedicated-neurocritical-care-team
#1
Yaw Sarpong, Premkumar Nattanmai, Ginger Schelp, Robert Bell, Keerthivaas Premkumar, Erin Stapleton, Ashley McCormick, Christopher R Newey
Introduction: Dedicated neurointensivists have been shown to improve outcome measurements in the neurosciences intensive care unit (NSICU). Quality outcome data in relation to patient and family satisfaction is lacking. This study evaluated the impact of newly appointed neurointensivists and creation of a neurocritical care team on quality outcome measures including patient satisfaction in a NSICU. Methods: This is a retrospective study of data over 36 months from a 14-bed NSICU evaluating quality outcome measures and anonymous patient satisfaction questionnaires before and after neurointensivists appointment...
2017: Critical Care Research and Practice
https://www.readbyqxmd.com/read/29113858/differences-in-blood-pressure-by-measurement-technique-in-neurocritically-ill-patients-a-technological-assessment
#2
Abhijit V Lele, Daren Wilson, Prabhakar Chalise, Jules Nazzaro, Vijay Krishnamoorthy, Monica S Vavilala
Blood pressure data may vary by measurement technique. We performed a technological assessment of differences in blood pressure measurement between non-invasive blood pressure (NIBP) and invasive arterial blood pressure (ABP) in neurocritically ill patients. After IRB approval, a prospective observational study was performed to study differences in systolic blood pressure (SBP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) values measured by NIBP arm, ABP at level of the phlebostatic axis (ABP heart) and ABP at level of the external auditory meatus (ABP brain) at 30 and 45-degree head of bed elevation (HOB) using repeated measure analysis of covariance and correlation coefficients...
November 4, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29107635/predictors-of-need-for-critical-care-support-adverse-events-and-outcome-after-stroke-thrombolysis
#3
Panagiotis Papamichalis, Spyridon Karagiannis, Efthimios Dardiotis, Achilleas Chovas, Dimitrios Papadopoulos, Tilemachos Zafeiridis, Dimitris Babalis, Georgios Paraforos, Vasiliki Zisopoulou, Apostolia-Lemonia Skoura, Ioannis Staikos, Konstantinos Bouliaris, Michail Papamichalis, Georgios Hadjigeorgiou, Apostolos Komnos
BACKGROUND: Results from trials and international registries exhibit heterogeneity regarding safety, efficacy, markers of prognosis, and markers of the need for critical care support after intravenous thrombolysis (IVT) for strokes. The purpose of our study was to indentify such markers after performance of comparisons among patients who received thrombolysis in our intensive care unit. MATERIALS AND METHODS: Our study included 124 patients who received IVT in accordance with international criteria...
October 26, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29103844/prediction-of-potential-for-organ-donation-after-circulatory-death-in-neurocritical-patients
#4
Guixing Xu, Zhiyong Guo, Wenhua Liang, Erye Xin, Bin Liu, Ye Xu, Zhongqin Luan, Paul Michael Schroder, Martí Manyalich, Dicken Shiu-Chung Ko, Xiaoshun He
BACKGROUND: The success or failure of donation after circulatory death depends largely on the functional warm ischemia time, which is closely related to the duration between withdrawal of life-sustaining treatment and circulatory arrest. However, a reliable predictive model for the duration is absent. We aimed to compare the performance of the Chinese Donation after Circulatory Death Nomogram (C-DCD-Nomogram) and 3 other tools in a cohort of potential donors. METHODS: In this prospective, multicenter, observational study, data were obtained from 219 consecutive neurocritical patients in China...
September 30, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/29095167/feasibility-of-early-motor-assisted-upper-extremity-cycle-ergometry-in-critically-ill-neurological-patients-with-upper-extremity-weakness-and-variable-cognitive-status-a-case-series
#5
S Deluzio, I Vora, S Kumble, E K Zink, R D Stevens, M N Bahouth
Upper extremity paresis, common in many neurological conditions, is a major contributor of long-term disability and decreased quality of life. Evidence shows that repetitive, bilateral arm movement improves upper extremity coordination after neurological injury. However, it is difficult to integrate upper extremity interventions into very early rehabilitation of critically ill neurological patients due to patient arousal and medical acuity. This report describes the safety and feasibility of bilateral upper extremity cycling in critically ill neurological patients with bilateral or unilateral paresis...
October 31, 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/29089921/the-neurological-wake-up-test-a-role-in-neurocritical-care-monitoring-of-traumatic-brain-injury-patients
#6
REVIEW
Niklas Marklund
The most fundamental clinical monitoring tool in traumatic brain injury (TBI) patients is the repeated clinical examination. In the severe TBI patient treated by continuous sedation in a neurocritical care (NCC) unit, sedation interruption is required to enable a clinical evaluation (named the neurological wake-up test; NWT) assessing the level of consciousness, pupillary diameter and reactivity to light, and presence of focal neurological deficits. There is a basic conflict regarding the NWT in the NCC setting; can the clinical information obtained by the NWT justify the risk of inducing a stress response in a severe TBI patient? Furthermore, in the presence of advanced multimodal monitoring and neuroimaging, is the NWT necessary to identify important clinical alterations? In studies of severe TBI patients, the NWT was consistently shown to induce a stress reaction including brief increases in intracranial pressure (ICP) and changes in cerebral perfusion pressure (CPP)...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29088962/complications-of-invasive-intracranial-pressure-monitoring-devices-in-neurocritical-care
#7
Samon Tavakoli, Geoffrey Peitz, William Ares, Shaheryar Hafeez, Ramesh Grandhi
Intracranial pressure monitoring devices have become the standard of care for the management of patients with pathologies associated with intracranial hypertension. Given the importance of invasive intracranial monitoring devices in the modern neurointensive care setting, gaining a thorough understanding of the potential complications related to device placement-and misplacement-is crucial. The increased prevalence of intracranial pressure monitoring as a management tool for neurosurgical patients has led to the publication of a plethora of papers regarding their indications and complications...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29088961/the-21st-century-challenge-to-neurocritical-care-the-rise-of-the-superbug-acinetobacter-baumannii-a-meta-analysis-of-the-role-of-intrathecal-or-intraventricular-antimicrobial-therapy-in-reduction-of-mortality
#8
Nasser Mohammed, Amey R Savardekar, Devi Prasad Patra, Vinayak Narayan, Anil Nanda
OBJECTIVE Neurosurgical infections due to multidrug-resistant organisms have become a nightmare that neurosurgeons are facing in the 21st century. This is the dawn of the so-called postantibiotic era. There is an urgent need to review and evaluate ways to reduce the high mortality rates due to these infections. The present study evaluates the efficacy of combined intravenous plus intrathecal or intraventricular (IV + IT) therapy versus only intravenous (IV) therapy in treating postneurosurgical Acinetobacter baumannii infections...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29088954/morbidity-and-mortality-associated-with-hypernatremia-in-patients-with-severe-traumatic-brain-injury
#9
Aditya Vedantam, Claudia S Robertson, Shankar P Gopinath
OBJECTIVE Hypernatremia is independently associated with increased mortality in critically ill patients. Few studies have evaluated the impact of hypernatremia on early mortality in patients with severe traumatic brain injury (TBI) treated in a neurocritical care unit. METHODS A retrospective review of patients with severe TBI (admission Glasgow Coma Scale score ≤ 8) treated in a single neurocritical care unit between 1986 and 2012 was performed. Patients with at least 3 serum sodium values were selected for the study...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29076474/-topical-respiratory-strategies-in-neurocritical-care
#10
M B Nazarenko, N M Kruglyakov, M S Semenov, M V Zabelin, Yu D Udalov, A S Samoylov, K A Popugaev
Management of the respiratory tract and maintenance of adequate gas exchange are the basic goals of critical care. Injury to the nervous system is often accompanied by development of respiratory disorders. On the other hand, changes in the gas composition of arterial blood can cause brain damage. In addition, approaches to the patient with respiratory failure, which are used in general critical care and neurocritical care, may differ. The presented literature review is devoted to modern respiratory strategies used in neurocritical care...
2017: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
https://www.readbyqxmd.com/read/29038971/the-implementation-of-targeted-temperature-management-an-evidence-based-guideline-from-the-neurocritical-care-society
#11
Lori Kennedy Madden, Michelle Hill, Teresa L May, Theresa Human, Mary McKenna Guanci, Judith Jacobi, Melissa V Moreda, Neeraj Badjatia
BACKGROUND: Targeted temperature management (TTM) is often used in neurocritical care to minimize secondary neurologic injury and improve outcomes. TTM encompasses therapeutic hypothermia, controlled normothermia, and treatment of fever. TTM is best supported by evidence from neonatal hypoxic-ischemic encephalopathy and out-of-hospital cardiac arrest, although it has also been explored in ischemic stroke, traumatic brain injury, and intracranial hemorrhage patients. Critical care clinicians using TTM must select appropriate cooling techniques, provide a reasonable rate of cooling, manage shivering, and ensure adequate patient monitoring among other challenges...
October 16, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29038077/the-effects-of-red-blood-cell-transfusion-on-functional-outcome-after-aneurysmal-subarachnoid-hemorrhage
#12
Monisha A Kumar, Joshua Levine, Jennifer Faerber, J Paul Elliott, H Richard Winn, Sean Doerfler, Peter Le Roux
BACKGROUND: The optimal red blood cell transfusion (RBCT) trigger for patients with aneurysmal subarachnoid hemorrhage (SAH) is unknown. In patients with cerebral vasospasm, anemia may increase susceptibility to ischemic injury; conversely, RBCT may worsen outcome given known deleterious effects. OBJECTIVE: To examine the association between RBCT, delayed cerebral ischemia, vasospasm, and outcome after SAH. METHODS: 421 consecutive SAH patients, admitted to a Neurocritical Care Unit at a University affiliated hospital and who underwent surgical occlusion of their ruptured aneurysm were retrospectively identified from a prospective observational database...
October 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29028696/brain-oxygen-optimization-in-severe-traumatic-brain-injury-phase-ii-a-phase-ii-randomized-trial
#13
RANDOMIZED CONTROLLED TRIAL
David O Okonkwo, Lori A Shutter, Carol Moore, Nancy R Temkin, Ava M Puccio, Christopher J Madden, Norberto Andaluz, Randall M Chesnut, M Ross Bullock, Gerald A Grant, John McGregor, Michael Weaver, Jack Jallo, Peter D LeRoux, Dick Moberg, Jason Barber, Christos Lazaridis, Ramon R Diaz-Arrastia
OBJECTIVES: A relationship between reduced brain tissue oxygenation and poor outcome following severe traumatic brain injury has been reported in observational studies. We designed a Phase II trial to assess whether a neurocritical care management protocol could improve brain tissue oxygenation levels in patients with severe traumatic brain injury and the feasibility of a Phase III efficacy study. DESIGN: Randomized prospective clinical trial. SETTING: Ten ICUs in the United States...
November 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28979514/a-case-for-stopping-the-early-withdrawal-of-life-sustaining-therapies-in-patients-with-devastating-brain-injuries
#14
Alex R Manara, Ian Thomas, Richard Harding
Early prognostication in patients with a devastating brain injury is not always accurate and can lead to inappropriate decisions. We present case histories to support the recent recommendations of the Neurocritical Care Society that treatment withdrawal decisions should be delayed by up to 72 h in these patients. Development of pathways incorporating these recommendations can improve prognostication, enhance end of life care given to these patients and their families, and increase the opportunities to explore the donation wishes of more patients...
November 2016: J Intensive Care Soc
https://www.readbyqxmd.com/read/28974999/malignant-posterior-reversible-encephalopathy-syndrome-an-exacting-challenge-for-neurocritical-care-physicians
#15
Shahvaiz Magsi, Atif Zafar
We report a case of malignant posterior reversible encephalopathy syndrome (PRES) in a 62-year-old Caucasian female with a complex medical history and comorbidities admitted for bowel resection and lysis of iatrogenic bowel adhesions and enterocutaneous fistulas. Postoperatively, the patient developed sudden bilateral visual loss with no other neurologic deficits. Computed tomography scan showed very severe PRES-like changes, confirmed on magnetic resonance imaging (MRI). Systolic blood pressure remained around 170 mm HG...
October 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28962816/shared-decision-making-in-neurocritical-care
#16
REVIEW
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...
November 2017: Neurologic Clinics
https://www.readbyqxmd.com/read/28962813/acute-cardiac-complications-in-critical-brain-disease
#17
REVIEW
Juan G Ripoll, Joseph L Blackshear, José L Díaz-Gómez
Acute cardiac complications in critical brain disease should be understood as a clinical condition representing an intense brain-heart crosstalk and might mimic ischemic heart disease. Two main entities (neurogenic stunned myocardium [NSM] and stress cardiomyopathy) have been better characterized in the neurocritically ill patients and they portend worse clinical outcomes in these cases. The pathophysiology of NSM remains elusive. However, significant progress has been made on the early identification of neurocardiac compromise following acute critical brain disease...
November 2017: Neurologic Clinics
https://www.readbyqxmd.com/read/28962806/cortical-spreading-depression-and-ischemia-in-neurocritical-patients
#18
REVIEW
Néstor Wainsztein, Federico Rodríguez Lucci
Spreading depolarization in cerebral cortex is associated with swelling of neurons, distortion of dendritic spines, massive ion translocation with a large change of the slow electrical potential, and silencing of brain electrical activity. The term spreading depression represents a wave of spontaneous activity of the electrocorticogram that propagates through contiguous cerebral gray matter at a characteristic velocity. Spreading depression is a consequence of cortical spreading depolarization. Therefore, spreading depolarization is not always accompanied by spreading depression and the terms are not synonymous...
November 2017: Neurologic Clinics
https://www.readbyqxmd.com/read/28962805/management-of-traumatic-brain-injury-an-update
#19
REVIEW
Mohamed H Abou El Fadl, Kristine H O'Phelan
The care of patients with traumatic brain injury can be one of the most challenging and rewarding aspects of clinical neurocritical care. This article reviews the approach to unique aspects specific to the care of this patient population. These aspects include appropriate use of sedation and analgesia, and the principles and the clinical use of intracranial monitors. Common clinical challenges encountered in these patients are also discussed, including the treatment of intracranial hypertension, temperature management, and control of sympathetic hyperactivity...
November 2017: Neurologic Clinics
https://www.readbyqxmd.com/read/28948503/extubating-the-neurocritical-care-patient-a-spontaneous-breathing-trial-algorithmic-approach
#20
Naresh Mullaguri, Zalan Khan, Premkumar Nattanmai, Christopher R Newey
BACKGROUND: Delaying extubation in neurologically impaired patients otherwise ready for extubation is a source for significant morbidity, mortality, and costs. There is no consensus to suggest one spontaneous breathing trial (SBT) over another in predicting extubation success. We studied an algorithm using zero pressure support and zero positive end-expiratory pressure (ZEEP) SBT followed by 5-cm H2O pressure support and 5-cm H2O positive end-expiratory pressure (i.e., 5/5) SBT in those who failed ZEEP SBT...
May 25, 2017: Neurocritical Care
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