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Neurocritical patient

Diane C McLaughlin, Margaret M Margretta, William D Freeman
INTRODUCTION: We hypothesized that a nocturnist advanced practice provider (APP) model compared with overnight neurocritical care coverage with general critical care physicians and neurology residents would provide similar patient outcomes, as measured by patient mortality. METHODS: This study is a retrospective review of healthcare outcomes of aneurysmal subarachnoid hemorrhage (aSAH) patients from 2013 and 2016, after implementation of specialty-trained neurocritical care nocturnist APPs...
April 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Athir Morad, Salia Farrokh, Alexander Papangelou
PURPOSE OF REVIEW: Pain management in neurocritical care is a subject often avoided because of concerns over the side-effects of analgesics and the potential to cause additional neurological injury with treatment. The sedation and hypercapnia caused by opioids have been feared to mask the neurological examination and contribute to elevations in intracranial pressure. Nevertheless, increasing attention to patient satisfaction has sparked a resurgence in pain management. As opioids have remained at the core of analgesic therapy, the increasing attention to pain has contributed to a growing epidemic of opioid dependence...
April 2018: Current Opinion in Critical Care
Vera Spatenkova, Ondrej Bradac, Daniela Fackova, Zdenka Bohunova, Petr Suchomel
BACKGROUND: Nosocomial infection (NI) control is an important issue in neurocritical care due to secondary brain damage and the increased morbidity and mortality of primary acute neurocritical care patients. The primary aim of this study was to determine incidence of nosocomial infections and multidrug-resistant bacteria and seek predictors of nosocomial infections in a preventive multimodal nosocomial infection protocol in the neurointensive care unit (NICU). The secondary aim focused on their impact on stay, mortality and cost in the NICU...
March 7, 2018: BMC Neurology
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
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...
April 2018: Neurosurgery Clinics of North America
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...
April 2018: Neurosurgery Clinics of North America
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...
April 2018: Neurosurgery Clinics of North America
Junji Wei, Rongcai Jiang, Lihong Li, Dezhi Kang, Guodong Gao, Chao You, Jianmin Zhang, Liang Gao, Qibing Huang, Duanwu Luo, Gang Zhao, Hongyi Zhang, Shuo Wang, Renzhi Wang
OBJECTIVE: China has limited data on stress-related gastrointestinal ulcers in patients admitted for neurosurgical care. This study evaluated the incidence of upper gastrointestinal bleeding (UGIB) and use of stress ulcer prophylaxis (SUP) in Chinese neurocritical care patients (Glasgow Coma Scale [GCS] score ≤ 10). METHODS: This multicenter, retrospective study was performed from January 2015 to July 2015. Medical records of 1468 patients hospitalized during 2014 were reviewed...
March 2, 2018: Current Medical Research and Opinion
Sergey A Abudeev, Kirill V Kiselev, Nikolay M Kruglyakov, Ksenia A Belousova, Inna N Lobanova, Oleg V Parinov, Yuriy D Udalov, Maxim A Zabelin, Alexandr S Samoilov, Evaldas Cesnulis, Tim Killeen, Konstantin A Popugaev
Background: Nosocomial CNS infection (NI-CNS) is a common and serious complication in neurocritical care patients. Timely, accurate diagnosis of NI-CNS is crucial, yet current infection markers lack specificity and/or sensitivity. Presepsin (PSP) is a novel biomarker of macrophage activation. Its utility in NI-CNS has not been explored. We first determined the normal range of cerebrospinal fluid (CSF) PSP in a control group without brain injury before collecting data on CSF PSP levels in neurocritical care patients...
2018: Frontiers in Neurology
Brandy B Ma, Emily L Johnson, Eva K Ritzl
INTRODUCTION: Neurocritical care units commonly implement the double-distance reduced EEG montage in postoperative neurosurgic patients who have structural barriers that hinder the placement of a standard 10-20 system array. Despite its widespread use, its sensitivity has not been adequately addressed. We evaluated the sensitivity and specificity of this montage for seizure detection. METHODS: One hundred fifty-five full-montage continuous EEGs (cEEGs) completed in the Johns Hopkins University neurocritical care unit containing unequivocal electrographic seizures, status epilepticus, or other abnormalities were selected, comprising 73 ictal and 82 nonictal EEGs...
February 21, 2018: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
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
Pablo Blanco, Anselmo Abdo-Cuza
Multimodality monitoring is a common practice in caring for neurocritically ill patients, and consists mainly in clinical assessment, intracranial pressure monitoring and using several imaging methods. Of these imaging methods, transcranial Doppler (TCD) is an interesting tool that provides a non-invasive, portable and radiation-free way to assess cerebral circulation and diagnose and follow-up (duplex method) intracranial mass-occupying lesions, such as hematomas and midline shift. This article reviews the basics of TCD applied to neurocritical care patients, offering a rationale for its use as well as tips for practitioners...
February 10, 2018: Journal of Ultrasound
Lucia Rivera-Lara, Andres Zorrilla-Vaca, Ryan J Healy, Wendy Ziai, Charles Hogue, Romergryko Geocadin, Batya Radzik, Caitlin Palmisano, Marek A Mirski
OBJECTIVE: Critical care guidelines recommend a single target value for mean arterial blood pressure in critically ill patients. However, growing evidence regarding cerebral autoregulation challenges this concept and supports individualizing mean arterial blood pressure targets to prevent brain and kidney hypo- or hyperperfusion. Regional cerebral oxygen saturation derived from near-infrared spectroscopy is an acceptable surrogate for cerebral blood flow and has been validated to measure cerebral autoregulation...
February 6, 2018: Critical Care Medicine
Merritt W Brown, Katie Ellen Foy, Christopher Chanda, Jacqueline Mulundika, Igor J Koralnik, Omar K Siddiqi
INTRODUCTION: Management of critically ill patients in dedicated intensive care units (ICUs) is the standard of care in high income countries (HICs), but remains uncommon in low and middle-income countries (LMICs). We sought to determine the prevalence of neurologic disorders in the ICU of a LMIC and examine if resource appropriate specialized neurocritical care training could benefit these patients. METHODS: From February to March 2017, a trained neurocritical care intensivist recorded encounters in the sole ICU at the University Teaching Hospital (UTH) in Lusaka, Zambia...
February 15, 2018: Journal of the Neurological Sciences
Lawrence J Hirsch, Nicolas Gaspard, Andreas van Baalen, Rima Nabbout, Sophie Demeret, Tobias Loddenkemper, Vincent Navarro, Nicola Specchio, Lieven Lagae, Andrea O Rossetti, Sara Hocker, Teneille E Gofton, Nicholas S Abend, Emily J Gilmore, Cecil Hahn, Houman Khosravani, Felix Rosenow, Eugen Trinka
We convened an international group of experts to standardize definitions of New-Onset Refractory Status Epilepticus (NORSE), Febrile Infection-Related Epilepsy Syndrome (FIRES), and related conditions. This was done to enable improved communication for investigators, physicians, families, patients, and other caregivers. Consensus definitions were achieved via email messages, phone calls, an in-person consensus conference, and collaborative manuscript preparation. Panel members were from 8 countries and included adult and pediatric experts in epilepsy, electroencephalography (EEG), and neurocritical care...
February 5, 2018: Epilepsia
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
Max Gaasch, Alois J Schiefecker, Mario Kofler, Ronny Beer, Verena Rass, Bettina Pfausler, Claudius Thomé, Erich Schmutzhard, Raimund Helbok
OBJECTIVES: Pressure reactivity index and oxygen reactivity index are used to assess cerebral autoregulation after acute brain injury. The value of autoregulation indices in the prediction of delayed cerebral ischemia and outcome in patients with subarachnoid hemorrhage is still inconclusive. In this study, we aimed to focus on the predictive value of the first 72 hours commonly referred to as "early brain injury" in comparison to the overall monitoring period. DESIGN: Retrospective observational cohort study...
February 1, 2018: Critical Care Medicine
Stefan Büttner, Andrea Stadler, Christoph Mayer, Sammy Patyna, Christoph Betz, Christian Senft, Helmut Geiger, Oliver Jung, Fabian Finkelmeier
PURPOSE: Acute kidney injury (AKI) is a severe complication in medical and surgical intensive care units accounting for a high morbidity and mortality. Incidence, risk factors, and prognostic impact of this deleterious condition are well established in this setting. Data concerning the neurocritically ill patients is scarce. Therefore, aim of this study was to determine the incidence of AKI and elucidate risk factors in this special population. METHODS: Patients admitted to a specialized neurocritical care unit between 2005 and 2011 with a length of stay above 48 hours were analyzed retrospectively for incidence, cause, and outcome of AKI (AKI Network-stage ≥2)...
January 1, 2018: Journal of Intensive Care Medicine
Arraya Watanitanon, Vivian H Lyons, Abhijit V Lele, Vijay Krishnamoorthy, Nophanan Chaikittisilpa, Theerada Chandee, Monica S Vavilala
OBJECTIVES: To characterize admission patterns, treatments, and outcomes among patients with moderate traumatic brain injury. DESIGN: Retrospective cohort study. SETTING: National Trauma Data Bank. PATIENTS: Adults (age > 18 yr) with moderate traumatic brain injury (International Classification of Diseases, Ninth revision codes and admission Glasgow Coma Scale score of 9-13) in the National Trauma Data Bank between 2007 and 2014...
January 23, 2018: Critical Care Medicine
Jeroen Hermanides, Mark P Plummer, Mark Finnis, Adam M Deane, Jonathan P Coles, David K Menon
BACKGROUND: Optimal glycaemic targets in traumatic brain injury (TBI) remain unclear. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing intensive with conventional glycaemic control in TBI requiring admission to an intensive care unit (ICU). METHODS: We systematically searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials to November 2016. Outcomes of interest included ICU and in-hospital mortality, poor neurological outcome, the incidence of hypoglycaemia and infective complications...
January 19, 2018: Critical Care: the Official Journal of the Critical Care Forum
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