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ElSaban M, Bhatt G, Lee J, Koshiya H, Mansoor T, Amal T, Kashyap R. A historical delve into neurotrauma-focused critical care. Wien Med Wochenschr 2023; 173:368-373. [PMID: 36729341 PMCID: PMC9892675 DOI: 10.1007/s10354-022-01002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/27/2022] [Indexed: 02/03/2023]
Abstract
Neurocritical care is a multidisciplinary field managing patients with a wide range of aliments. Specifically, neurotrauma is a rapidly growing field with increasing demands. The history of how neurotrauma management came to its current form has not been extensively explored before. Our review delves into the history, timeline, and noteworthy pioneers of neurotrauma-focused neurocritical care. We explore the historical development during early times, the 18th-20th centuries, and modern times, as well as warfare- and sports-related concussions. Research is ever growing in this budding field, with several promising innovations on the horizon.
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Affiliation(s)
- Mariam ElSaban
- Department of Anesthesiology, Mayo Clinic, Rochester, MN USA
| | - Gaurang Bhatt
- All India Institute of Medical Sciences, Rishikesh, India
| | - Joanna Lee
- David Tvildiani Medical University, Tbilisi, Georgia
| | - Hiren Koshiya
- Department of Hematology & Oncology, Mayo Clinic, Jacksonville, USA Florida
| | | | - Tanya Amal
- Maulana Azad Medical College, New Delhi, India
| | - Rahul Kashyap
- Department of Critical Care Medicine, Mayo Clinic, Rochester, MN USA
- Medical director research, WellSpan Health, New York, PA USA
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Shemme AJ, Phillips JN, Bloise R, Koehler TJ, Gorelick PB, Francis BA. The Impact of a Neurocritical Care and Neuropalliative Collaboration on Intensive Care Unit Outcomes. Am J Hosp Palliat Care 2022; 39:687-694. [PMID: 35040688 DOI: 10.1177/10499091211060055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Neurocritical care (NCC) and neuropalliative care (NPC) clinicians provide care in specialized intensive care units (ICU). There is a paucity of data regarding the impact of NCC and NPC collaboration in smaller, community-focused settings. OBJECTIVE To determine the clinical impact of introducing a NCC/NPC collaborative model in a mixed ICU community-based teaching hospital. DESIGN Retrospective pre/post cohort study. SUBJECTS Patients ≥18 years of age admitted to the ICU who received neurology and palliative care consultations between September 1, 2015 and August 31, 2017 at a 300 bed community-focused hospital were included. INTERVENTION The addition of a NCC/NPC collaborative model took place in September of 2016. The time periods before (9/1/2015 to 8/31/2016) and after (9/1/2016 to 8/31/2017) the addition were compared. RESULTS A total of 274 admissions (pre: 130, post: 144) were included. There were significantly more NCC consultations provided in the post-period (44.6% vs 57.6%; P = .03). NPC consultation increased (55.4% vs 66.7%; P = .056) Median LOS was significantly shorter after implementation of the collaborative model (11 vs 8 days; P = .01). Median ICU LOS was also shorter by 1 ICU-day in the post-period, though this was not statistically significant (P = .23). Mortality rates were similar (P = .95). CONCLUSIONS Our findings suggest NCC/NPC collaboration in a community-focused teaching hospital was associated with more NCC consultations, as well as shorter LOS without increasing mortality. These data highlight the importance of supporting collaborative models of care in community settings. Further research is warranted.
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Affiliation(s)
- Andersen J Shemme
- Department of Neurology, 24752Hauenstein Neurosciences Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Joel N Phillips
- Department of Neurology, 24752Hauenstein Neurosciences Mercy Health Saint Mary's, Grand Rapids, MI, USA.,Department of Palliative and Supportive Care, 24752Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Rafael Bloise
- Department of Palliative and Supportive Care, 24752Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Tracy J Koehler
- Scholarly Activity Solutions, LLC-Grand Rapids, Grand Rapids, MI, USA
| | - Philip B Gorelick
- Department of Neurology, 24752Hauenstein Neurosciences Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Brandon A Francis
- Department of Neurology and Ophthalmology, 3078Michigan State University, Lansing, MI, USA
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Ali KM, Salih MH, AbuGabal HH, Omer MEA, Ahmed AE, Abbasher Hussien Mohamed Ahmed K. Outcome of neurocritical disorders, a multicenter prospective cross-sectional study. Brain Behav 2022; 12:e2540. [PMID: 35196419 PMCID: PMC8933777 DOI: 10.1002/brb3.2540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Patients with neurocritical disorders who require admission to intensive care units (ICUs) constitute about 10-15% of critical care cases. OBJECTIVES To study the outcome of neurocritical disorders in intensive care units. METHODOLOGY This is a prospective cross-sectional study that was conducted among neurocritical patients who were admitted in four intensive care units of four major hospitals in Khartoum state during the period from November 2020 to March 2021. RESULTS Seventy-two neurocritical patients were included in this study; 40(55.6%) were males and 32(44.4%) were females. Twenty-one (29.2%) patients fully recovered, 35 (48.6%) partially recovered and 16 (22.2%) died. The mortality of the common neurocritical diseases were as follows: stroke 30.4%, encephalitis (8.3%), status epilepticus (11.1%), Guillain-Barre syndrome (GBS) (16.7%), and myasthenia gravis (MG) (25%). CONCLUSION This study identified that near two-thirds of the patients required mechanical ventilation. Delayed admission was observed due to causes distributed between the medical side and patient side. The majority of patients were discharged from ICU with partial recovery.
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Affiliation(s)
| | - Mahmoud Hussien Salih
- Faculty of Medicine, Department of Medicine, University of Gezira, Wad Madani, Sudan
| | - Hiba Hassan AbuGabal
- Department of Internal Medicine, Fajr College for Science and Technology, Khartoum, Sudan
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Neves G, Cole T, Lee J, Bueso T, Shaw C, Montalvan V. Demographic and institutional predictors of stroke hospitalization mortality among adults in the United States. eNeurologicalSci 2022; 26:100392. [PMID: 35146139 PMCID: PMC8802002 DOI: 10.1016/j.ensci.2022.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/24/2021] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Stroke remains a primary source of functional disability and inpatient mortality in the United States (US). Recent evidence reveals declining mortality associated with stroke hospitalizations in the US. However, data updating trends in inpatient mortality is lacking. This study aims to provide a renewed inpatient stroke mortality rate in a national sample and identify common predictors of inpatient stroke mortality. Methods In this cross-sectional study, we analyzed data from a nationwide database between 2010 and 2017. We included patient encounters for both ischemic (ICD9 433–434, ICD10 I630–I639) and hemorrhagic stroke (ICD9 430–432, ICD10 I600–I629). We performed an annual comparison of in-hospital stroke mortality rates, and a cross-sectional analytic approach of multiple variables identified common predictors of inpatient stroke mortality. Results Between 2010 and 2017, we identified 518,185 total stroke admissions (86.6% ischemic stroke and 13.4% hemorrhagic strokes). Stroke admissions steadily increased during the studied period, whereas we observed a steady decline in in-hospital mortality during the same time. The inpatient stroke mortality rate gradually declined from 4.8% in 2010 (95% CI 4.6–5.1) to 2.1% in 2017 (95% CI 2.0–2.1). Predictors of higher odds of dying from ischemic stroke were female (OR 1.059, 95% CI 1.015–1.105, p = 0.008), older age (OR 1.028, 95% CI 1.026–1.029, p < 0.001), and sicker patients (OR 1.091, 95% CI 1.089–1.093, p < 0.001). Predictors of higher odds of dying from hemorrhagic stroke were Hispanic ethnicity (OR 1.459, 95% CI 1.084–1.926, p < 0.001), older age (OR 1.021, 95% CI 1.019–1.023, p < 0.001), and sicker patients (OR 1.042, 95% CI 1.039–1.045, p < 0.001). All census regions and hospital types demonstrated improvements in in-hospital mortality. Conclusion This study identified a continuous declining rate in in-hospital mortality due to stroke in the United States, and it also identified demographic and hospital predictors of inpatient stroke mortality. Stroke remains a leading cause of morbidity and mortality in the United States Stroke hospitalization mortality trends are important to guide efforts in acute stroke care Vascular risk factors are still prevalent in the population admitted due to stroke and continue to be associated with higher odds of death There are important regional disparities in stroke hospitalization deaths in the United States Hospital characteristics influence odds of death from a stroke independent of stroke etiology
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Affiliation(s)
- Gabriel Neves
- Department of Neurology, Texas Tech University Medical Sciences Center, Lubbock, TX, USA
- Corresponding author at: Department of Neurology, Texas Tech University Health Sciences Center, Room 3A105, 3601 4 street, Lubbock, TX 79430, USA.
| | - Travis Cole
- Graduate School of Biomedical Sciences, Texas Tech University Medical Sciences Center, Lubbock, TX, USA
| | - Jeannie Lee
- Department of Neurology, Texas Tech University Medical Sciences Center, Lubbock, TX, USA
| | - Tulio Bueso
- Department of Neurology, Texas Tech University Medical Sciences Center, Lubbock, TX, USA
| | - Chip Shaw
- Graduate School of Biomedical Sciences, Texas Tech University Medical Sciences Center, Lubbock, TX, USA
| | - Victor Montalvan
- Department of Neurology, Texas Tech University Medical Sciences Center, Lubbock, TX, USA
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Madsen FA, Andreasen TH, Lindschou J, Gluud C, Møller K. Ketamine for critically ill patients with severe acute brain injury: Protocol for a systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials. PLoS One 2021; 16:e0259899. [PMID: 34780543 PMCID: PMC8592463 DOI: 10.1371/journal.pone.0259899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Intensive care for patients with severe acute brain injury aims both to treat the immediate consequences of the injury and to prevent and treat secondary brain injury to ensure a good functional outcome. Sedation may be used to facilitate mechanical ventilation, for treating agitation, and for controlling intracranial pressure. Ketamine is an N-methyl-D-aspartate receptor antagonist with sedative, analgesic, and potentially neuroprotective properties. We describe a protocol for a systematic review of randomised clinical trials assessing the beneficial and harmful effects of ketamine for patients with severe acute brain injury. METHODS AND ANALYSIS We will systematically search international databases for randomised clinical trials, including CENTRAL, MEDLINE, Embase, and trial registries. Two authors will independently review and select trials for inclusion, and extract data. We will compare ketamine by any regimen versus placebo, no intervention, or other sedatives or analgesics for patients with severe acute brain injury. The primary outcomes will be functional outcome at maximal follow up, quality of life, and serious adverse events. We will also assess secondary and exploratory outcomes. The extracted data will be analysed using Review Manager and Trials Sequential Analysis. Evidence certainty will be graded using GRADE. ETHICS AND DISSEMINATION The results of the systematic review will be disseminated through peer-reviewed publication. With the review, we hope to inform future randomised clinical trials and improve clinical practice. PROSPERO NO CRD42021210447.
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Affiliation(s)
- Frederik Andreas Madsen
- Department of Neuroanaesthesiology, Neuroscience Centre, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Trine Hjorslev Andreasen
- Department of Neurosurgery, Neuroscience Centre, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Kirsten Møller
- Department of Neuroanaesthesiology, Neuroscience Centre, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Lau KHV, Hamlyn E, Williams TJ, Qureshi MM, Mak K, Mian A, Cervantes-Arslanian A, Zhu S, Takahashi C. The Effects of Video Instruction on Neuroscience Intensive Care Unit Nursing Skills in Case Presentations and Neurological Examinations. J Neurosci Nurs 2021; 53:129-133. [PMID: 33840806 DOI: 10.1097/jnn.0000000000000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT BACKGROUND: The emergence of neuroscience intensive care units (NSICUs) for the past decades has led to growing interest in targeted training for NSICU nurses. We sought to evaluate the use of video instruction on NSICU nurses' skills in case presentations and neurological examinations, which has timely advantages as an asynchronous and distanced learning modality. METHODS: We enrolled NSICU and surgical intensive care unit nurses who took shifts in the NSICU at our institution. Participants were observed by a neurocritical care attending physician presenting the clinical details of an admitted patient and conducting a neurological examination, with both parties completing a 10-item evaluation on NSICU nursing presentation and examination skills. Participants randomized to an intervention group were given access to an instructional video on NSICU nursing skills. A median of 21 days later, participants were observed by a physician blinded to study randomization, with both parties recompleting the evaluation. Differences between day 1 and day 21 scores were analyzed using paired sample t tests. RESULTS: Fifteen NSICU and 55 surgical intensive care unit nurses were enrolled. Surgical intensive care unit nurses in both the intervention and control groups had statistically significant improvement between day 1 and day 21 physician-rated scores, with a greater increase in the intervention group; self-rated scores did not change. For NSICU nurses, there were no differences in physician-rated or self-rated scores for either group. CONCLUSIONS: Surgical intensive care unit nurses who underwent direct observation and self-evaluation had improvement in physician-rated NSICU nursing skills, likely as these activities allowed for reflective observation in Kolb's experiential learning cycle. Greater improvement in participants who viewed an instructional video highlights its value as a teaching modality for nurses.
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Halstead MR, Geocadin RG. The Medical Management of Cerebral Edema: Past, Present, and Future Therapies. Neurotherapeutics 2019; 16:1133-1148. [PMID: 31512062 PMCID: PMC6985348 DOI: 10.1007/s13311-019-00779-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Cerebral edema is commonly associated with cerebral pathology, and the clinical manifestation is largely related to the underlying lesioned tissue. Brain edema usually amplifies the dysfunction of the lesioned tissue and the burden of cerebral edema correlates with increased morbidity and mortality across diseases. Our modern-day approach to the medical management of cerebral edema has largely revolved around, an increasingly artificial distinction between cytotoxic and vasogenic cerebral edema. These nontargeted interventions such as hyperosmolar agents and sedation have been the mainstay in clinical practice and offer noneloquent solutions to a dire problem. Our current understanding of the underlying molecular mechanisms driving cerebral edema is becoming much more advanced, with differences being identified across diseases and populations. As our understanding of the underlying molecular mechanisms in neuronal injury continues to expand, so too is the list of targeted therapies in the pipeline. Here we present a brief review of the molecular mechanisms driving cerebral edema and a current overview of our understanding of the molecular targets being investigated.
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Affiliation(s)
- Michael R Halstead
- Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology-Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA.
| | - Romergryko G Geocadin
- Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology-Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA
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Xu R, Tan C, Zhu J, Zeng X, Gao X, Wu Q, Chen Q, Wang H, Zhou H, He Y, Pan S, Yin J. Dysbiosis of the intestinal microbiota in neurocritically ill patients and the risk for death. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:195. [PMID: 31151471 PMCID: PMC6544929 DOI: 10.1186/s13054-019-2488-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/22/2019] [Indexed: 12/15/2022]
Abstract
Background Despite the essential functions of the intestinal microbiota in human physiology, little has been reported about the microbiome in neurocritically ill patients. This investigation aimed to evaluate the characteristics of the gut microbiome in neurocritically ill patients and its changes after admission. Furthermore, we investigated whether the characteristics of the gut microbiome at admission were a risk factor for death within 180 days. Methods This prospective observational cohort study included neurocritically ill patients admitted to the neurological intensive care unit of a large university-affiliated academic hospital in Guangzhou. Faecal samples were collected within 72 h after admission (before antibiotic treatment) and serially each week. Healthy volunteers were recruited from a community in Guangzhou. The gut microbiome was monitored via 16S rRNA gene sequence analysis, and the associations with the clinical outcome were evaluated by a Cox proportional hazards model. Results In total, 98 patients and 84 age- and sex-matched healthy subjects were included in the analysis. Compared with healthy subjects, the neurocritically ill patients exhibited significantly different compositions of intestinal microbiota. During hospitalization, the α-diversity and abundance of Ruminococcaceae and Lachnospiraceae decreased significantly over time in patients followed longitudinally. The abundance of Enterobacteriaceae was positively associated with the modified Rankin Scale at discharge. In the multivariate Cox regression analysis, Christensenellaceae and Erysipelotrichaceae were associated with an increased risk of death. The increases in intestinal Enterobacteriales and Enterobacteriaceae during the first week in the neurological intensive care unit were associated with increases of 92% in the risk of 180-day mortality after adjustments. Conclusions This analysis of the gut microbiome in 98 neurocritically ill patients indicates that the gut microbiota composition in these patients differs significantly from that in a healthy population and that the magnitude of this dysbiosis increases during hospitalization in a neurological intensive care unit. The gut microbiota characteristics seem to have an impact on patients’ 180-day mortality. Gut microbiota analysis could hopefully predict outcome in the future. Electronic supplementary material The online version of this article (10.1186/s13054-019-2488-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruoting Xu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chuhong Tan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiajia Zhu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiuli Zeng
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xuxuan Gao
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiheng Wu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiong Chen
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Huidi Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hongwei Zhou
- State Key Laboratory of Organ Failure Research, Microbiome Medicine Center, Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Yan He
- State Key Laboratory of Organ Failure Research, Microbiome Medicine Center, Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| | - Suyue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Jia Yin
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Implementation of Neurocritical Care Is Associated With Improved Outcomes in Traumatic Brain Injury. Can J Neurol Sci 2017; 44:350-357. [PMID: 28343456 DOI: 10.1017/cjn.2017.25] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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. METHODS We conducted a single-center quasi-experimental uncontrolled pre- and post-NCC study in severe traumatic brain injury patients (Glasgow Coma Scale ≤8). The NCC program includes consultation with a neurointensivist and neurosurgeon and multimodal neuromonitoring. Demographic, injury severity metrics, neurophysiologic data, and therapeutic interventions were collected. Glasgow Outcome Scale (GOS) at 6 months was the primary outcome. Multivariable ordinal logistic regression was used to model the association between NCC implementation and GOS at 6 months. RESULTS A total of 113 patients were identified: 76 pre-NCC and 37 post-NCC. Mean age was 39 years (standard deviation [SD], 2) and 87 of 113 (77%) patients were male. Median admission motor score was 3 (interquartile ratio, 1-4). Daily mean arterial pressure was higher (95 mmHg [SD, 10]) versus (88 mmHg [SD, 10], p<0.001) and daily mean core body temperature was lower (36.6°C [SD, 0.90]) versus (37.2°C [SD, 1.0], p=0.001) post-NCC compared with pre-NCC, respectively. Multivariable regression modelling revealed the NCC program was associated with a 2.5 increased odds (odds ratios, 2.5; 95% confidence interval, 1.1-5.3; p=0.022) of improved 6-month GOS. CONCLUSIONS Implementation of a NCC program is associated with improved 6 month GOS in severe TBI patients.
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Wijdicks EFM, Menon DK, Smith M. Ten things you need to know to practice neurological critical care. Intensive Care Med 2014; 41:318-21. [PMID: 25398306 DOI: 10.1007/s00134-014-3544-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Eelco F M Wijdicks
- Division of Critical Care Neurology, Mayo Clinic, 200 First Street SW, MN, Rochester, 55905, USA,
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