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Kim S, Oh TK, Song IA, Jeon YT. Trend of Intensive Care Unit Admission in Neurology-Neurosurgery Adult Patients in South Korea : A Nationwide Population-Based Cohort Study. J Korean Neurosurg Soc 2024; 67:84-93. [PMID: 37558211 PMCID: PMC10788545 DOI: 10.3340/jkns.2023.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/25/2023] [Accepted: 08/05/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE We aimed to examine trends in critically ill neurology-neurosurgery (NNS) patients who were admitted to the intensive care unit (ICU) in South Korea and identify risk factors for in-hospital mortality after ICU admission in NNS patients. METHODS This nationwide population-based retrospective cohort study enrolled adult NNS adult patients admitted to the ICU from 2010 to 2019 extracted from the National Health Insurance Service in South Korea. The critically ill NNS patients were defined as those whose main admission departments were neurology or neurosurgery at ICU admission. The number of ICU admission, age, and total cost for hospitalization from 2010 to 2019 in critically ill NNS patients were examined as trend information. Moreover, multivariable logistic regression modeling was used to identify risk factors for in-hospital mortality among critically ill NNS patients. RESULTS We included 845474 ICU admission cases for 679376 critically ill NNS patients in South Korea between January 1, 2010 to December 31, 2019. The total number of ICU admissions among NNS patients was 79522 in 2010, which increased to 91502 in 2019. The mean age rose from 62.8 years (standard deviation [SD], 15.6) in 2010 to 66.6 years (SD, 15.2) in 2019, and the average total cost for hospitalization per each patient consistently increased from 6206.1 USD (SD, 5218.5) in 2010 to 10745.4 USD (SD, 10917.4) in 2019. In-hospital mortality occurred in 75455 patients (8.9%). Risk factors strongly associated with increased in-hospital mortality were the usage of mechanical ventilator (adjusted odds ratio [aOR], 19.83; 95% confidence interval [CI], 19.42-20.26; p<0.001), extracorporeal membrane oxygenation (aOR, 3.49; 95% CI, 2.42-5.02; p<0.001), and continuous renal replacement therapy (aOR, 6.47; 95% CI, 6.02-6.96; p<0.001). In addition, direct admission to ICU from the emergency room (aOR, 1.38; 95% CI, 1.36-1.41; p<0.001) and brain cancer as the main diagnosis (aOR, 1.30; 95% CI, 1.22-1.39; p<0.001) are also potential risk factors for increased in-hospital mortality. CONCLUSION In South Korea, the number of ICU admissions increased among critically ill NNS patients from 2010 to 2019. The average age and total costs for hospitalization also increased. Some potential risk factors are found to increase in-hospital mortality among critically ill NNS patients.
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Affiliation(s)
- Saeyeon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea
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Morgan M. Intensive care 2.0. Anaesthesia 2023; 78:413-415. [PMID: 36629760 DOI: 10.1111/anae.15954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 01/12/2023]
Affiliation(s)
- M Morgan
- Curtin University, Perth, WA, Australia.,The Royal Perth Hospital, Perth, WA, Australia
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Abstract
OBJECTIVES Critically ill patients are at high risk of acute brain injury. Bedside multimodality neuromonitoring techniques can provide a direct assessment of physiologic interactions between systemic derangements and intracranial processes and offer the potential for early detection of neurologic deterioration before clinically manifest signs occur. Neuromonitoring provides measurable parameters of new or evolving brain injury that can be used as a target for investigating various therapeutic interventions, monitoring treatment responses, and testing clinical paradigms that could reduce secondary brain injury and improve clinical outcomes. Further investigations may also reveal neuromonitoring markers that can assist in neuroprognostication. We provide an up-to-date summary of clinical applications, risks, benefits, and challenges of various invasive and noninvasive neuromonitoring modalities. DATA SOURCES English articles were retrieved using pertinent search terms related to invasive and noninvasive neuromonitoring techniques in PubMed and CINAHL. STUDY SELECTION Original research, review articles, commentaries, and guidelines. DATA EXTRACTION Syntheses of data retrieved from relevant publications are summarized into a narrative review. DATA SYNTHESIS A cascade of cerebral and systemic pathophysiological processes can compound neuronal damage in critically ill patients. Numerous neuromonitoring modalities and their clinical applications have been investigated in critically ill patients that monitor a range of neurologic physiologic processes, including clinical neurologic assessments, electrophysiology tests, cerebral blood flow, substrate delivery, substrate utilization, and cellular metabolism. Most studies in neuromonitoring have focused on traumatic brain injury, with a paucity of data on other clinical types of acute brain injury. We provide a concise summary of the most commonly used invasive and noninvasive neuromonitoring techniques, their associated risks, their bedside clinical application, and the implications of common findings to guide evaluation and management of critically ill patients. CONCLUSIONS Neuromonitoring techniques provide an essential tool to facilitate early detection and treatment of acute brain injury in critical care. Awareness of the nuances of their use and clinical applications can empower the intensive care team with tools to potentially reduce the burden of neurologic morbidity in critically ill patients.
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Affiliation(s)
- Swarna Rajagopalan
- Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ
| | - Aarti Sarwal
- Department of Neurology, Atrium Wake Forest School of Medicine, Winston-Salem, NC
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Chang N, Rasmussen L. Exploring Trends in Neuromonitoring Use in a General Pediatric ICU: The Need for Standardized Guidance. CHILDREN (BASEL, SWITZERLAND) 2022; 9:934. [PMID: 35883918 PMCID: PMC9324621 DOI: 10.3390/children9070934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 12/26/2022]
Abstract
Neuromonitoring has become more standardized in adult neurocritical care, but the utility of different neuromonitoring modalities in children remains debated. We aimed to describe the use of neuromonitoring in critically ill children with and without primary neurological diseases. We conducted a retrospective review of patients admitted to a 32-bed, non-cardiac PICU during a 12-month period. Neuro-imaging, electroencephalogram (EEG), cerebral oximetry (NIRS), automated pupillometry, transcranial doppler (TCD), intracranial pressure (ICP) monitoring, brain tissue oxygenation (PbtO2), primary diagnosis, and outcome were extracted. Neuromonitoring use by primary diagnosis and associations with outcome were observed. Of 1946 patients, 420 received neuro-imaging or neuromonitoring. Primary non-neurological diagnoses most frequently receiving neuromonitoring were respiratory, hematologic/oncologic, gastrointestinal/liver, and infectious/inflammatory. The most frequently used technologies among non-neurological diagnoses were neuro-imaging, EEG, pupillometry, and NIRS. In the multivariate analysis, pupillometry use was associated with mortality, and EEG, NIRS, and neuro-imaging use were associated with disability. Frequencies of TCD and PbtO2 use were too small for analysis. Neuromonitoring is prevalent among various diagnoses in the PICU, without clear benefit on outcomes when used in an ad hoc fashion. We need standard guidance around who, when, and how neuromonitoring should be applied to improve the care of critically ill children.
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Affiliation(s)
- Nathan Chang
- Pediatric Critical Care Medicine and Neurocritical Care, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA 94304, USA;
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Challenges and Opportunities in Multimodal Monitoring and Data Analytics in Traumatic Brain Injury. Curr Neurol Neurosci Rep 2021; 21:6. [PMID: 33527217 PMCID: PMC7850903 DOI: 10.1007/s11910-021-01098-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW Increasingly sophisticated systems for monitoring the brain have led to an increase in the use of multimodality monitoring (MMM) to detect secondary brain injuries before irreversible damage occurs after brain trauma. This review examines the challenges and opportunities associated with MMM in this population. RECENT FINDINGS Locally and internationally, the use of MMM varies. Practical challenges include difficulties with data acquisition, curation, and harmonization with other data sources limiting collaboration. However, efforts toward integration of MMM data, advancements in data science, and the availability of cloud-based infrastructures are now affording the opportunity for MMM to advance the care of patients with brain trauma. MMM provides data to guide the precision management of patients with traumatic brain injury in real time. While challenges exist, there are exciting opportunities for MMM to live up to this promise and to drive new insights into the physiology of the brain and beyond.
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Predicting adult neuroscience intensive care unit admission from emergency department triage using a retrospective, tabular-free text machine learning approach. Sci Rep 2021; 11:1381. [PMID: 33446890 PMCID: PMC7809037 DOI: 10.1038/s41598-021-80985-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/28/2020] [Indexed: 12/23/2022] Open
Abstract
Early admission to the neurosciences intensive care unit (NSICU) is associated with improved patient outcomes. Natural language processing offers new possibilities for mining free text in electronic health record data. We sought to develop a machine learning model using both tabular and free text data to identify patients requiring NSICU admission shortly after arrival to the emergency department (ED). We conducted a single-center, retrospective cohort study of adult patients at the Mount Sinai Hospital, an academic medical center in New York City. All patients presenting to our institutional ED between January 2014 and December 2018 were included. Structured (tabular) demographic, clinical, bed movement record data, and free text data from triage notes were extracted from our institutional data warehouse. A machine learning model was trained to predict likelihood of NSICU admission at 30 min from arrival to the ED. We identified 412,858 patients presenting to the ED over the study period, of whom 1900 (0.5%) were admitted to the NSICU. The daily median number of ED presentations was 231 (IQR 200–256) and the median time from ED presentation to the decision for NSICU admission was 169 min (IQR 80–324). A model trained only with text data had an area under the receiver-operating curve (AUC) of 0.90 (95% confidence interval (CI) 0.87–0.91). A structured data-only model had an AUC of 0.92 (95% CI 0.91–0.94). A combined model trained on structured and text data had an AUC of 0.93 (95% CI 0.92–0.95). At a false positive rate of 1:100 (99% specificity), the combined model was 58% sensitive for identifying NSICU admission. A machine learning model using structured and free text data can predict NSICU admission soon after ED arrival. This may potentially improve ED and NSICU resource allocation. Further studies should validate our findings.
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Baldassano SN, Roberson SW, Balu R, Scheid B, Bernabei JM, Pathmanathan J, Oommen B, Leri D, Echauz J, Gelfand M, Bhalla PK, Hill CE, Christini A, Wagenaar JB, Litt B. IRIS: A Modular Platform for Continuous Monitoring and Caretaker Notification in the Intensive Care Unit. IEEE J Biomed Health Inform 2020; 24:2389-2397. [PMID: 31940568 PMCID: PMC7485608 DOI: 10.1109/jbhi.2020.2965858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE New approaches are needed to interpret large amounts of physiologic data continuously recorded in the ICU. We developed and prospectively validated a versatile platform (IRIS) for real-time ICU physiologic monitoring, clinical decision making, and caretaker notification. METHODS IRIS was implemented in the neurointensive care unit to stream multimodal time series data, including EEG, intracranial pressure (ICP), and brain tissue oxygenation (PbtO2), from ICU monitors to an analysis server. IRIS was applied for 364 patients undergoing continuous EEG, 26 patients undergoing burst suppression monitoring, and four patients undergoing intracranial pressure and brain tissue oxygen monitoring. Custom algorithms were used to identify periods of elevated ICP, compute burst suppression ratios (BSRs), and detect faulty or disconnected EEG electrodes. Hospital staff were notified of clinically relevant events using our secure API to route alerts through a password-protected smartphone application. RESULTS Sustained increases in ICP and concordant decreases in PbtO2 were reliably detected using user-defined thresholds and alert throttling. BSR trends computed by the platform correlated highly with manual neurologist markings (r2 0.633-0.781; p < 0.0001). The platform identified EEG electrodes with poor signal quality with 95% positive predictive value, and reduced latency of technician response by 93%. CONCLUSION This study validates a flexible real-time platform for monitoring and interpreting ICU data and notifying caretakers of actionable results, with potential to reduce the manual burden of continuous monitoring services on care providers. SIGNIFICANCE This work represents an important step toward facilitating translational medical data analytics to improve patient care and reduce health care costs.
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Chatrath A, Soldozy S, Sokolowski JD, Burke RM, Schultz JG, Rannigan ZC, Park MS. Endovascular and Surgical Treatment Is Predictive of Readmission Risk After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2020; 142:e494-e501. [PMID: 32693223 DOI: 10.1016/j.wneu.2020.07.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) is a debilitating disease process accounting for 5% of strokes. Although improvements in care have reduced the case-fatality rates, patients have an increased risk of neurological and medical complications after discharge. Additionally, the readmission rates have been increasingly used as a metric for patient care quality. METHODS In the present study, we reviewed the medical records of 206 patients who had been treated for aSAH at the University of Virginia from 2011 to 2018 to identify the causes and predictors of readmission. RESULTS The all-cause readmission rate was 9.8%, 15.3%, and 21.3% within 30, 60, and 180 days, respectively. The readmission rate for neurologic causes was 7.7%, 12.6%, and 18.0% within 30, 60, and 180 days, respectively. The neurologic causes of readmission included aneurysm retreatment, cranioplasty, a fall, hydrocephalus, stroke symptoms, and syncope. Surgical treatment (odds ratio [OR], 4.11-6.30) and endovascular treatment (OR, 3.79-8.33) of vasospasm were associated with an increased risk of all-cause readmission. Endovascular aneurysm treatment (OR, 0.22) was associated with a decreased risk of all-cause readmission. The average interval to the first follow-up appointment at our institution was 55.3 ± 63.3 days. Of the patients who had been readmitted from the emergency room, 65% had not had follow-up contact with physicians at our institution until their readmission. CONCLUSIONS To the best of our knowledge, the present study is the first to have examined the readmission rates for subarachnoid hemorrhage >90 days after treatment. Our results have suggested that the readmission rates >90 days after treatment could still be predicted by the hospital and treatment course during admission and that follow-up appointments with patients earlier in the clinic could identify those patients with a greater risk of readmission.
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Affiliation(s)
- Ajay Chatrath
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Sauson Soldozy
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Jennifer D Sokolowski
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Rebecca M Burke
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Julianne G Schultz
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Zuseen C Rannigan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Min S Park
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
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Kim TJ, Lee JS, Yoon JS, Oh MS, Kim JW, Jung KH, Yu KH, Lee BC, Ko SB, Yoon BW. Impact of the Dedicated Neurointensivists on the Outcome in Patients with Ischemic Stroke Based on the Linked Big Data for Stroke in Korea. J Korean Med Sci 2020; 35:e135. [PMID: 32476299 PMCID: PMC7261699 DOI: 10.3346/jkms.2020.35.e135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/22/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Neurocritical care by dedicated neurointensivists may improve outcomes of critically ill patients with severe brain injury. In this study, we aimed to validate whether neurointensive care could improve the outcome in patients with critically ill acute ischemic stroke using the linked big dataset on stroke in Korea. METHODS We included 1,405 acute ischemic stroke patients with mechanical ventilator support in the intensive care unit after an index stroke. Patients were retrieved from linking the Clinical Research Center for Stroke Registry and the Health Insurance Review and Assessment Service data from the period between January 2007 and December 2014. The outcomes were mortality at discharge and at 3 months after an index stroke. The main outcomes were compared between the centers with and without dedicated neurointensivists. RESULTS Among the included patients, 303 (21.6%) were admitted to the centers with dedicated neurointensivists. The patients treated by dedicated neurointensivists had significantly lower in-hospital mortality (18.3% vs. 26.8%, P = 0.002) as well as lower mortality at 3-month (38.0% vs. 49.1%, P < 0.001) than those who were treated without neurointensivists. After adjusting for confounders, a treatment without neurointensivists was independently associated with higher in-hospital mortality (odds ratio [OR], 1.59; 95% confidence intervals [CIs], 1.13-2.25; P = 0.008) and 3-month mortality (OR, 1.48; 95% CIs, 1.12-1.95; P = 0.005). CONCLUSION Treatment by dedicated neurointensivists is associated with lower in-hospital and 3-month mortality using the linked big datasets for stroke in Korea. This finding stresses the importance of neurointensivists in treating patients with severe ischemic stroke.
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Affiliation(s)
- Tae Jung Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji Sung Lee
- Department of Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sun Yoon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji Woo Kim
- Health Insurance Review and Assessment Service, Wonju, Korea
| | - Keun Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Kyung Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Byung Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang Bae Ko
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Byung Woo Yoon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.
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Silva GS, Maldonado NJ, Mejia-Mantilla JH, Ortega-Gutierrez S, Claassen J, Varelas P, Suarez JI. Neuroemergencies in South America: How to Fill in the Gaps? Neurocrit Care 2020; 31:573-582. [PMID: 31342447 DOI: 10.1007/s12028-019-00775-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
South America is a subcontinent with 393 million inhabitants with widely distinct countries and diverse ethnicities, cultures, political and societal organizations. The epidemiological transition that accompanied the technological and demographic evolution is happening in South America and leading to a rise in the incidence of neurodegenerative and cardiovascular diseases that now coexist with the still high burden of infectious diseases. South America is also quite heterogeneous regarding the existence of systems of care for the various neurological emergencies, with some countries having well-organized systems for some diseases, while others have no plan of action for the care of patients with acute neurological symptoms. In this article, we discuss the existing systems of care in different countries of South America for the treatment of neurological emergencies, mainly stroke, status epilepticus, and traumatic brain injury. We also will address existing gaps between the current systems and recommendations from the literature to improve the management of such emergencies, as well as strategies on how to solve these disparities.
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Affiliation(s)
- Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP) and Albert Einstein Hospital, Albert Einstein Street, 627, Suite 218, São Paulo, SP, 05652-900, Brazil.
| | | | | | | | | | | | - Jose I Suarez
- Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lien R. Neurocritical care of premature infants. Biomed J 2020; 43:259-267. [PMID: 32333994 PMCID: PMC7424083 DOI: 10.1016/j.bj.2020.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 12/17/2022] Open
Abstract
Neurocritical care is an approach of comprehensive care through multidisciplinary coordination and implementation of neuroprotective strategies to reduce the risk of neurologic injury among critically ill patients. Premature infants are at a special risk of sustaining brain injury and having adverse neurodevelopmental outcome. The pathogenesis of “encephalopathy of prematurity” is tightly linked to hemodynamic instability during postnatal transition, immaturity of the cerebral vascular bed and nervous system, and the commonly encountered inflammation in an intensive care setting. Clinical assessment aided by renewed monitoring techniques, together with therapies supported by best available evidence may provide opportunities to salvage these vulnerable brains. Indeed, to promote optimal brain development and to ensure neurodevelopmental intact survival is of imperial priority in the modern care of preterm infants.
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Affiliation(s)
- Reyin Lien
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Venkatasubba Rao CP, Suarez JI, Martin RH, Bauza C, Georgiadis A, Calvillo E, Hemphill JC, Sung G, Oddo M, Taccone FS, LeRoux PD. Global Survey of Outcomes of Neurocritical Care Patients: Analysis of the PRINCE Study Part 2. Neurocrit Care 2020; 32:88-103. [PMID: 31486027 DOI: 10.1007/s12028-019-00835-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the Point PRevalence In Neurocritical CarE (PRINCE) study, a prospective, cross-sectional, observational study. METHODS We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and in-hospital mortality. We present descriptive statistics to summarize data from the case report form. We tested differences between geographically grouped data using parametric and nonparametric testing as appropriate. We used a multivariable logistic regression model to evaluate factors associated with in-hospital mortality. RESULTS We analyzed data from 1545 patients admitted to 147 participating sites from 31 countries of which most were from North America (69%, N = 1063). Globally, there was variability in patient characteristics, admission diagnosis, ICU treatment team and resource allocation, and in-hospital mortality. Seventy-three percent of the participating centers were academic, and the most common admitting diagnosis was subarachnoid hemorrhage (13%). The majority of patients were male (59%), a half of whom had at least two comorbidities, and median Glasgow Coma Scale (GCS) of 13. Factors associated with in-hospital mortality included age (OR 1.03; 95% CI, 1.02 to 1.04); lower GCS (OR 1.20; 95% CI, 1.14 to 1.16 for every point reduction in GCS); pupillary reactivity (OR 1.8; 95% CI, 1.09 to 3.23 for bilateral unreactive pupils); admission source (emergency room versus direct admission [OR 2.2; 95% CI, 1.3 to 3.75]; admission from a general ward versus direct admission [OR 5.85; 95% CI, 2.75 to 12.45; and admission from another ICU versus direct admission [OR 3.34; 95% CI, 1.27 to 8.8]); and the absence of a dedicated neurocritical care unit (NCCU) (OR 1.7; 95% CI, 1.04 to 2.47). CONCLUSION PRINCE is the first study to evaluate care patterns of neurocritical patients worldwide. The data suggest that there is a wide variability in clinical care resources and patient characteristics. Neurological severity of illness and the absence of a dedicated NCCU are independent predictors of in-patient mortality.
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MESH Headings
- Academic Medical Centers/statistics & numerical data
- Adult
- Aged
- Asia/epidemiology
- Brain Injuries, Traumatic/epidemiology
- Brain Injuries, Traumatic/physiopathology
- Brain Injuries, Traumatic/therapy
- Brain Neoplasms/epidemiology
- Brain Neoplasms/physiopathology
- Brain Neoplasms/therapy
- Cerebral Hemorrhage/epidemiology
- Cerebral Hemorrhage/physiopathology
- Cerebral Hemorrhage/therapy
- Critical Care
- Disease Management
- Emergency Service, Hospital
- Europe/epidemiology
- Female
- Glasgow Coma Scale
- Health Resources
- Heart Arrest/epidemiology
- Heart Arrest/physiopathology
- Heart Arrest/therapy
- Hematoma, Subdural/epidemiology
- Hematoma, Subdural/physiopathology
- Hematoma, Subdural/therapy
- Hemodynamic Monitoring/statistics & numerical data
- Hospital Mortality
- Hospitals, Private/statistics & numerical data
- Hospitals, Public/statistics & numerical data
- Humans
- Intensive Care Units
- Internationality
- Ischemic Stroke/epidemiology
- Ischemic Stroke/physiopathology
- Ischemic Stroke/therapy
- Latin America/epidemiology
- Length of Stay/statistics & numerical data
- Logistic Models
- Male
- Middle Aged
- Middle East/epidemiology
- Multivariate Analysis
- Neurophysiological Monitoring/statistics & numerical data
- North America/epidemiology
- Oceania/epidemiology
- Odds Ratio
- Palliative Care/statistics & numerical data
- Patient Admission/statistics & numerical data
- Patient Comfort
- Patient Transfer/statistics & numerical data
- Referral and Consultation/statistics & numerical data
- Reflex, Pupillary
- Resuscitation Orders
- Risk Factors
- Severity of Illness Index
- Subarachnoid Hemorrhage/epidemiology
- Subarachnoid Hemorrhage/physiopathology
- Subarachnoid Hemorrhage/therapy
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Affiliation(s)
- Chethan P Venkatasubba Rao
- Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine and CHI Baylor St Luke's Medical Center, Houston, TX, USA
| | - Jose I Suarez
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 3014C, Baltimore, MD, 21287, USA.
| | - Renee H Martin
- Medical University of South Carolina, Charleston, SC, USA
| | - Colleen Bauza
- Department of Health Informatics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Alexandros Georgiadis
- Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine and CHI Baylor St Luke's Medical Center, Houston, TX, USA
| | - Eusebia Calvillo
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 3014C, Baltimore, MD, 21287, USA
| | | | - Gene Sung
- University of Southern California, Los Angeles, CA, USA
| | - Mauro Oddo
- CHUV Lausanne University Hospital, Lausanne, Switzerland
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13
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Kim SH, Yum KS, Jeong JH, Choi JH, Park HS, Song YJ, Kim DH, Cha JK, Han MK. Impact of Neurointensivist Co-Management in a Semiclosed Neurocritical-Care Unit. J Clin Neurol 2020; 16:681-687. [PMID: 33029976 PMCID: PMC7541986 DOI: 10.3988/jcn.2020.16.4.681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose The importance of the specialized management of neurocritical patients is being increasingly recognized. We evaluated the impact of neurointensivist comanagement on the clinical outcomes (particularly the mortality rate) of neurocritical patients admitted to a semiclosed neurocritical-care unit (NCU). Methods We retrospectively included neurocritical patients admitted to the NCU between March 2015 and February 2018. We analyzed the clinical data and compared the outcomes between patients admitted before and after the initiation of neurointensivist co-management in March 2016. Results There were 1,785 patients admitted to the NCU during the study period. Patients younger than 18 years (n=28) or discharged within 48 hours (n=200) were excluded. The 1,557 remaining patients comprised 590 and 967 who were admitted to the NCU before and after the initiation of co-management, respectively. Patients admitted under neurointensivist co-management were older and had higher Acute Physiologic Assessment and Chronic Health Evaluation II scores. The 30-day mortality rate was significantly lower after neurointensivist co-management (p=0.042). A multivariate logistic regression analysis demonstrated that neurointensivist co-management significantly reduced mortality rates in the NCU and in the hospital overall [odds ratio=0.590 (p=0.002) and 0.585 (p=0.001), respectively]. Conclusions Despite the higher severity of the condition during neurointensivist co-management, co-management significantly improved clinical outcomes (including the mortality rate) in neurocritical patients.
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Affiliation(s)
- Sang Hwa Kim
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Kyu Sun Yum
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Jin Heon Jeong
- Department of Intensive Care Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.,Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.,Stroke Center, Dong-A University Hospital, Busan, Korea.
| | - Jae Hyung Choi
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.,Stroke Center, Dong-A University Hospital, Busan, Korea
| | - Hyun Seok Park
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.,Stroke Center, Dong-A University Hospital, Busan, Korea
| | - Young Jin Song
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Dae Hyun Kim
- Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.,Stroke Center, Dong-A University Hospital, Busan, Korea
| | - Jae Kwan Cha
- Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.,Stroke Center, Dong-A University Hospital, Busan, Korea
| | - Moon Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
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14
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Ostermann M, Vincent JL. How much centralization of critical care services in the era of telemedicine? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:423. [PMID: 31878965 PMCID: PMC6933622 DOI: 10.1186/s13054-019-2705-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 12/16/2019] [Indexed: 11/14/2022]
Affiliation(s)
- Marlies Ostermann
- Department of Critical Care, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
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15
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Neonatal Neurocritical Care: Providing Brain-Focused Care for All at Risk Neonates. Semin Pediatr Neurol 2019; 32:100774. [PMID: 31813520 DOI: 10.1016/j.spen.2019.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neonatal neurocritical care is an evolving subsubspecialty whose goal is to implement neuroprotective care strategies, continuous bedside monitoring of neurologic function, and therapies in order to reduce the risk of neurologic injury and improve long-term neurodevelopmental outcomes in neonates who require intensive care. The provision of neonatal neurocritical care requires a culture change across a Neonatal Intensive Care Unit (NICU) in which equal importance is placed on the neurologic care and the cardiorespiratory care of a given patient. It is a multidisciplinary framework of care in which neonatologist and pediatric neurologist come together to address the unique needs of NICU patients whose brains are still developing and are vulnerable to injury. Advances in bedside brain monitoring techniques and the use of therapeutic hypothermia for Hupoxic-Ischemic Encephalopathy have accelerated the development of NeuroNICUs across the United States and abroad. Neonatologists, neurologists, neurophysiologists, nurses, and other ancillary members of the team work together to develop guidelines for commonly encountered neurological conditions in the NICU. The use of these guidelines helps provide standardized care across a unit and can reduce morbidity and length of hospital stay.
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16
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Baldassano SN, Hill CE, Shankar A, Bernabei J, Khankhanian P, Litt B. Big data in status epilepticus. Epilepsy Behav 2019; 101:106457. [PMID: 31444029 PMCID: PMC6944751 DOI: 10.1016/j.yebeh.2019.106457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/26/2019] [Indexed: 12/23/2022]
Abstract
Status epilepticus care and treatment are already being touched by the revolution in data science. New approaches designed to leverage the tremendous potential of "big data" in the clinical sphere are enabling researchers and clinicians to extract information from sources such as administrative claims data, the electronic medical health record, and continuous physiologic monitoring data streams. Algorithmic methods of data extraction also offer potential to fuse multimodal data (including text-based documentation, imaging data, and time-series data) to improve patient assessment and stratification beyond the manual capabilities of individual physicians. Still, the potential of data science to impact the diagnosis, treatment, and minute-to-minute care of patients with status epilepticus is only starting to be appreciated. In this brief review, we discuss how data science is impacting the field and draw examples from the following three main areas: (1) analysis of insurance claims from large administrative datasets to evaluate the impact of continuous electroencephalogram (EEG) monitoring on clinical outcomes; (2) natural language processing of the electronic health record to find, classify, and stratify patients for prognostication and treatment; and (3) real-time systems for data analysis, data reduction, and multimodal data fusion to guide therapy in real time. While early, it is our hope that these examples will stimulate investigators to leverage data science, computer science, and engineering methods to improve the care and outcome of patients with status epilepticus and other neurological disorders. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures".
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Affiliation(s)
- Steven N. Baldassano
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, Philadelphia, PA 19104, United States,Center for Neuroengineering and Therapeutics, University of Pennsylvania, 240 South 33rd Street, Philadelphia, PA 19104, United States
| | - Chloé E. Hill
- Department of Neurology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Arjun Shankar
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, Philadelphia, PA 19104, United States,Center for Neuroengineering and Therapeutics, University of Pennsylvania, 240 South 33rd Street, Philadelphia, PA 19104, United States
| | - John Bernabei
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, Philadelphia, PA 19104, United States,Center for Neuroengineering and Therapeutics, University of Pennsylvania, 240 South 33rd Street, Philadelphia, PA 19104, United States
| | - Pouya Khankhanian
- Department of Neurology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States,Department of Neurology, Penn Epilepsy Center, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Brian Litt
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, Philadelphia, PA 19104, United States,Center for Neuroengineering and Therapeutics, University of Pennsylvania, 240 South 33rd Street, Philadelphia, PA 19104, United States,Department of Neurology, Penn Epilepsy Center, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
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17
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Roychoudhury S, Esser MJ, Buchhalter J, Bello-Espinosa L, Zein H, Howlett A, Thomas S, Murthy P, Appendino JP, Scott JN, Metcalfe C, Lind J, Oliver N, Kozlik S, Mohammad K. Implementation of Neonatal Neurocritical Care Program Improved Short-Term Outcomes in Neonates With Moderate-to-Severe Hypoxic Ischemic Encephalopathy. Pediatr Neurol 2019; 101:64-70. [PMID: 31047757 DOI: 10.1016/j.pediatrneurol.2019.02.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Despite the introduction of therapeutic hypothermia, infants with moderate-to-severe hypoxic-ischemic encephalopathy remain at risk of mortality and morbidity. A dedicated service with standardized management protocols and improved communication may help improve care. We aimed to evaluate the impact of a dedicated neonatal neurocritical care service on short-term outcomes in infants with hypoxic-ischemic encephalopathy. METHODS We performed a retrospective cohort study (July 2008 to December 2017) on term and near-term infants admitted to two tertiary neonatal intensive care units with moderate-to-severe hypoxic-ischemic encephalopathy, before and after neonatal neurocritical care service implementation. The primary outcome was brain magnetic resonance imaging findings consistent with those of hypoxic-ischemic encephalopathy. Secondary outcomes included the cooling initiation rate, hospital stay duration, antiseizure medication use, and inotrope use. Regression analysis and interrupted time series analysis were performed after adjusting for confounding factors. RESULTS In total, 216 infants with moderate-to-severe hypoxic-ischemic encephalopathy were analyzed-109 before and 107 after neonatal neurocritical care implementation. After adjusting for confounding factors, there was a significant reduction in primary outcomes (adjusted odds ratio: 0.3, confidence interval: 0.15 to 0.57, P < 0.001) after neonatal neurocritical care implementation. Average hospital stay duration reduced by 5.2 days per infant (P = 0.03), identification of eligible infants for cooling improved (P < 0.001), antiseizure medication use reduced (P = 0.001), and early inotropes use reduced (P = 0.04). CONCLUSION Implementation of a neonatal neurocritical care service associated with decreased brain injury shortened the hospital stay duration and improved the care of infants with moderate-to-severe hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Smita Roychoudhury
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Michael J Esser
- Section of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey Buchhalter
- Section of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Luis Bello-Espinosa
- Section of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Hussein Zein
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Alexandra Howlett
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Sumesh Thomas
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Prashanth Murthy
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Juan Pablo Appendino
- Section of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - James N Scott
- Departments of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Cathy Metcalfe
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jan Lind
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Norma Oliver
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Silvia Kozlik
- Section of Pediatric Neurology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Khorshid Mohammad
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
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Abstract
BACKGROUND Acute neurological emergencies (ANEs) in children are common life-threatening illnesses and are associated with high mortality and severe neurological disability in survivors, if not recognized early and treated appropriately. We describe our experience of teaching a short, novel course "Pediatric Neurologic Emergency Life Support" to pediatricians and trainees in a resource-limited country. METHODS This course was conducted at 5 academic hospitals from November 2013 to December 2014. It is a hybrid of pediatric advance life support and emergency neurologic life support. This course is designed to increase knowledge and impart practical training on early recognition and timely appropriate treatment in the first hour of children with ANEs. Neuroresuscitation and neuroprotective strategies are key components of this course to prevent and treat secondary injuries. Four cases of ANEs (status epilepticus, nontraumatic coma, raised intracranial pressure, and severe traumatic brain injury) were taught as a case simulation in a stepped-care, protocolized approach based on best clinical practices with emphasis on key points of managements in the first hour. RESULTS Eleven courses were conducted during the study period. One hundred ninety-six physicians including 19 consultants and 171 residents participated in these courses. The mean (SD) score was 65.15 (13.87%). Seventy percent (132) of participants were passed (passing score > 60%). The overall satisfaction rate was 85%. CONCLUSIONS Pediatric Neurologic Emergency Life Support was the first-time delivered educational tool to improve outcome of children with ANEs with good achievement and high satisfaction rate of participants. Large number courses are required for future validation.
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19
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Ryu JA, Yang JH, Chung CR, Suh GY, Hong SC. Impact of Neurointensivist Co-management on the Clinical Outcomes of Patients Admitted to a Neurosurgical Intensive Care Unit. J Korean Med Sci 2017; 32:1024-1030. [PMID: 28480662 PMCID: PMC5426243 DOI: 10.3346/jkms.2017.32.6.1024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/10/2017] [Indexed: 12/03/2022] Open
Abstract
Limited data are available on improved outcomes after initiation of neurointensivist co-management in neurosurgical intensive care units (NSICUs) in Korea. We evaluated the impact of a newly appointed neurointensivist on the outcomes of neurosurgical patients admitted to an intensive care unit (ICU). This retrospective observational study involved neurosurgical patients admitted to the NSICU at Samsung Medical Center between March 2013 and May 2016. Neurointensivist co-management was initiated in October 1 2014. We compared the outcomes of neurosurgical patients before and after neurointensivist co-management. The primary outcome was ICU mortality. A total of 571 patients were admitted to the NSICU during the study period, 291 prior to the initiation of neurointensivist co-management and 280 thereafter. Intracranial hemorrhage (29.6%) and traumatic brain injury (TBI) (26.6%) were the most frequent reasons for ICU admission. TBI was the most common cause of death (39.0%). There were no significant differences in mortality rates and length of ICU stay before and after co-management. However, the rates of ICU and 30-day mortality among the TBI patients were significantly lower after compared to before initiation of neurointensivist co-management (8.5% vs. 22.9%; P = 0.014 and 11.0% vs. 27.1%; P = 0.010, respectively). Although overall outcomes were not different after neurointensivist co-management, initiation of a strategy of routine involvement of a neurointensivist significantly reduced the ICU and 30-day mortality rates of TBI patients.
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Affiliation(s)
- Jeong Am Ryu
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Chyul Hong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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20
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Jeong JH, Bang J, Jeong W, Yum K, Chang J, Hong JH, Lee K, Han MK. A Dedicated Neurological Intensive Care Unit Offers Improved Outcomes for Patients With Brain and Spine Injuries. J Intensive Care Med 2017; 34:104-108. [PMID: 28460590 DOI: 10.1177/0885066617706675] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Admission to an intensive care unit (ICU) specialized for brain and spine injury patients is associated with improved outcome. We investigated the effects of the first dedicated, combined neurological and neurosurgical ICU (NeuroICU) in Korea on patient outcomes. METHODS The first dedicated NeuroICU in Korea was established in March 2013. We retrospectively analyzed the clinical data and compared the outcomes between patients admitted to the ICU before and after NeuroICU establishment. The predicted mortality of NeuroICU patients was calculated using their Acute Physiology and Chronic Health Evaluation II scores. Patients' functional outcomes were evaluated using their modified Rankin scale (mRS) scores at 6 months after ICU admission, which were obtained from medical records or telephone interviews. RESULTS We included 2487 patients, 1572 and 915 of whom were admitted prior to and after NeuroICU establishment, respectively. The demographic characteristics, Glasgow Coma Scale scores, and disease proportions did not differ significantly between the groups. The length of ICU stay and the number of days on ventilation were significantly lower in NeuroICU patients than they were in general ICU patients ( P = .024, P = .001). Intensive care unit mortality was significantly lower in NeuroICU patients (7.3% vs 4.7%, P = .012). The predicted mortality was obtained from 473 NeuroICU patients. The mortality ratio (observed mortality/predicted mortality) was 0.34 (8.9%/26.1%), and 228 (48.1%) patients showed good functional recovery (mRS, 0-2). CONCLUSION Our findings suggest that admission to a dedicated NeuroICU significantly improves the neurological outcomes of patients with brain and spine injuries, including their postoperative care, in Korea.
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Affiliation(s)
- Jin-Heon Jeong
- 1 Department of Intensive Care Medicine and Neurology, Stroke Center, Dong-A University Hospital, Busan, South Korea.,These authors contributed equally to this work
| | - JaeSeung Bang
- 2 Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.,These authors contributed equally to this work
| | - WonJoo Jeong
- 2 Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - KyuSun Yum
- 3 Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - JunYoung Chang
- 4 Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Jeong-Ho Hong
- 5 Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Kiwon Lee
- 6 Department of Neurology and Neurosurgery, The University of Texas Houston Medical School and Memorial Hermann Texas Medical Center, Houston, TX, United States
| | - Moon-Ku Han
- 3 Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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21
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Mackey J, Khoury JC, Alwell K, Moomaw CJ, Kissela BM, Flaherty ML, Adeoye O, Woo D, Ferioli S, De Los Rios La Rosa F, Martini S, Khatri P, Broderick JP, Zuccarello M, Kleindorfer D. Stable incidence but declining case-fatality rates of subarachnoid hemorrhage in a population. Neurology 2016; 87:2192-2197. [PMID: 27770074 DOI: 10.1212/wnl.0000000000003353] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/11/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize temporal trends in subarachnoid hemorrhage (SAH) incidence and outcomes over 5 time periods in a large population-based stroke study in the United States. METHODS All SAHs among residents of the Greater Cincinnati/Northern Kentucky region at least 20 years of age were identified and verified via study physician review in 5 distinct year-long study periods between 1988 and 2010. We abstracted demographics, care patterns, and outcomes, and we compared incidence and case-fatality rates across the study periods. RESULTS The incidence of SAH in the 5 study periods (age-, race-, and sex-adjusted to the 2000 US population) was 8.8 (95% confidence interval 6.8-10.7), 9.2 (7.2-11.2), 10.0 (8.0-12.0), 9.0 (7.1-10.9), and 7.7 (6.0-9.4) per 100,000, respectively; the trend in incidence rates from 1988 to 2010 was not statistically significant (p = 0.22). Advanced neurovascular imaging, endovascular coiling, and neurologic intensive care unit availability increased significantly over time. All-cause 5-day (32%-18%, p = 0.01; for trend), 30-day (46%-25%, p = 0.001), and 90-day (49%-29%, p = 0.001) case-fatality rates declined from 1988 to 2010. When we included only proven or highly likely aneurysmal SAH, the declines in case-fatality were no longer statistically significant. CONCLUSIONS Although the incidence of SAH remained stable in this population-based region, 5-day, 30-day, and 90-day case-fatality rates declined significantly. Advances in surgical and medical management, along with systems-based changes such as the emergence of neurocritical care units, are potential explanations for the reduced case-fatality.
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Affiliation(s)
- Jason Mackey
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX.
| | - Jane C Khoury
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX
| | - Kathleen Alwell
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX
| | - Charles J Moomaw
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX
| | - Brett M Kissela
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX
| | - Matthew L Flaherty
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX
| | - Opeolu Adeoye
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX
| | - Daniel Woo
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX
| | - Simona Ferioli
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX
| | - Felipe De Los Rios La Rosa
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX
| | - Sharyl Martini
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX
| | - Pooja Khatri
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX
| | - Joseph P Broderick
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX
| | - Mario Zuccarello
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX
| | - Dawn Kleindorfer
- From the Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Division of Biostatistics and Epidemiology (J.C.K.), Cincinnati Children's Hospital; Departments of Neurology (K.A., C.J.M., B.M.K., M.L.F., D.W., S.F., F.D.L.R.L.R., P.K., J.P.B., D.K.), Emergency Medicine (O.A.), and Neurosurgery (M.Z.), University of Cincinnati College of Medicine, OH; Department of Neurology (F.D.L.R.L.R.), University of New Mexico Health Sciences Center, Albuquerque; and Department of Neurology (S.M.), Baylor College of Medicine, Houston, TX
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English JD, Yavagal DR, Gupta R, Janardhan V, Zaidat OO, Xavier AR, Nogueira RG, Kirmani JF, Jovin TG. Mechanical Thrombectomy-Ready Comprehensive Stroke Center Requirements and Endovascular Stroke Systems of Care: Recommendations from the Endovascular Stroke Standards Committee of the Society of Vascular and Interventional Neurology (SVIN). INTERVENTIONAL NEUROLOGY 2016; 4:138-50. [PMID: 27051410 DOI: 10.1159/000442715] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Five landmark multicenter, prospective, randomized, open-label, blinded end point clinical trials have recently demonstrated significant clinical benefit of endovascular therapy with mechanical thrombectomy in acute ischemic stroke (AIS) patients presenting with proximal intracranial large vessel occlusions. The Society of Vascular and Interventional Neurology (SVIN) appointed an expert writing committee to summarize this new evidence and make recommendations on how these data should guide emergency endovascular therapy for AIS patients.
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Affiliation(s)
- Joey D English
- Neurointerventional Surgery, California Pacific Medical Center, San Francisco, Calif., USA
| | - Dileep R Yavagal
- Neurology and Neurosurgery, University of Miami School of Medicine, Miami, Fla., USA
| | - Rishi Gupta
- Neurosurgery, WellStar Medical Group, Marietta, Ga., USA
| | | | | | | | | | - Jawad F Kirmani
- Stroke and Neurovascular Center, JFK Medical Center, Edison, N.J., USA
| | - Tudor G Jovin
- Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pa., USA
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de Oliveira Manoel AL, Goffi A, Marotta TR, Schweizer TA, Abrahamson S, Macdonald RL. The critical care management of poor-grade subarachnoid haemorrhage. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:21. [PMID: 26801901 PMCID: PMC4724088 DOI: 10.1186/s13054-016-1193-9] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Aneurysmal subarachnoid haemorrhage is a neurological syndrome with complex systemic complications. The rupture of an intracranial aneurysm leads to the acute extravasation of arterial blood under high pressure into the subarachnoid space and often into the brain parenchyma and ventricles. The haemorrhage triggers a cascade of complex events, which ultimately can result in early brain injury, delayed cerebral ischaemia, and systemic complications. Although patients with poor-grade subarachnoid haemorrhage (World Federation of Neurosurgical Societies 4 and 5) are at higher risk of early brain injury, delayed cerebral ischaemia, and systemic complications, the early and aggressive treatment of this patient population has decreased overall mortality from more than 50% to 35% in the last four decades. These management strategies include (1) transfer to a high-volume centre, (2) neurological and systemic support in a dedicated neurological intensive care unit, (3) early aneurysm repair, (4) use of multimodal neuromonitoring, (5) control of intracranial pressure and the optimisation of cerebral oxygen delivery, (6) prevention and treatment of medical complications, and (7) prevention, monitoring, and aggressive treatment of delayed cerebral ischaemia. The aim of this article is to provide a summary of critical care management strategies applied to the subarachnoid haemorrhage population, especially for patients in poor neurological condition, on the basis of the modern concepts of early brain injury and delayed cerebral ischaemia.
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Affiliation(s)
- Airton Leonardo de Oliveira Manoel
- St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. .,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
| | - Alberto Goffi
- Toronto Western Hospital MSNICU, 2nd Floor McLaughlin Room 411-H, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Tom R Marotta
- St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada
| | - Simon Abrahamson
- St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada
| | - R Loch Macdonald
- St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada
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24
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Abstract
Telestroke and teleneurologic intensive care units (teleneuro-ICUs) optimize the diagnosis and treatment of neurologic emergencies. Establishment of a telestroke or teleneuro-ICU program relies on investment in experienced stroke and neurocritical care personnel as well as advanced telecommunications technologies. Telemanagement of neurologic emergencies can be standardized to improve outcomes, but it is essential to have a relationship with a tertiary care facility that can use endovascular, neurosurgical, and neurocritical care advanced therapies after stabilization. The next stage in telestroke/teleneuro-ICU management involves the use of mobile stroke units to shorten the time to treatment in neurocritically ill patients.
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Rishi MA, Kashyap R, Wilson G, Schenck L, Hocker S. Association of Extubation Failure and Functional Outcomes in Patients with Acute Neurologic Illness. Neurocrit Care 2015. [DOI: 10.1007/s12028-015-0156-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Caldwell M, Hapuarachchi T, Highton D, Elwell C, Smith M, Tachtsidis I. BrainSignals Revisited: Simplifying a Computational Model of Cerebral Physiology. PLoS One 2015; 10:e0126695. [PMID: 25961297 PMCID: PMC4427507 DOI: 10.1371/journal.pone.0126695] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
Multimodal monitoring of brain state is important both for the investigation of healthy cerebral physiology and to inform clinical decision making in conditions of injury and disease. Near-infrared spectroscopy is an instrument modality that allows non-invasive measurement of several physiological variables of clinical interest, notably haemoglobin oxygenation and the redox state of the metabolic enzyme cytochrome c oxidase. Interpreting such measurements requires the integration of multiple signals from different sources to try to understand the physiological states giving rise to them. We have previously published several computational models to assist with such interpretation. Like many models in the realm of Systems Biology, these are complex and dependent on many parameters that can be difficult or impossible to measure precisely. Taking one such model, BrainSignals, as a starting point, we have developed several variant models in which specific regions of complexity are substituted with much simpler linear approximations. We demonstrate that model behaviour can be maintained whilst achieving a significant reduction in complexity, provided that the linearity assumptions hold. The simplified models have been tested for applicability with simulated data and experimental data from healthy adults undergoing a hypercapnia challenge, but relevance to different physiological and pathophysiological conditions will require specific testing. In conditions where the simplified models are applicable, their greater efficiency has potential to allow their use at the bedside to help interpret clinical data in near real-time.
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Affiliation(s)
- Matthew Caldwell
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Tharindi Hapuarachchi
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, University College London, London, UK
| | - David Highton
- Neurocritical Care Unit, University College Hospitals, London, UK
| | - Clare Elwell
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Martin Smith
- Neurocritical Care Unit, University College Hospitals, London, UK
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
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27
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Skoglund K, Hillered L, Purins K, Tsitsopoulos PP, Flygt J, Engquist H, Lewén A, Enblad P, Marklund N. The neurological wake-up test does not alter cerebral energy metabolism and oxygenation in patients with severe traumatic brain injury. Neurocrit Care 2015; 20:413-26. [PMID: 23934408 DOI: 10.1007/s12028-013-9876-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The neurological wake-up test (NWT) is used to monitor the level of consciousness in patients with traumatic brain injury (TBI). However, it requires interruption of sedation and may elicit a stress response. We evaluated the effects of the NWT using cerebral microdialysis (MD), brain tissue oxygenation (PbtiO2), jugular venous oxygen saturation (SjvO2), and/or arterial-venous difference (AVD) for glucose, lactate, and oxygen in patients with severe TBI. METHODS Seventeen intubated TBI patients (age 16-74 years) were sedated using continuous propofol infusion. All patients received intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring in addition to MD, PbtiO2 and/or SjvO2. Up to 10 days post-injury, ICP, CPP, PbtiO2 (51 NWTs), MD (49 NWTs), and/or SjvO2 (18 NWTs) levels during propofol sedation (baseline) and NWT were compared. MD was evaluated at a flow rate of 1.0 μL/min (28 NWTs) or the routine 0.3 μL/min rate (21 NWTs). RESULTS The NWT increased ICP and CPP levels (p < 0.05). Compared to baseline, interstitial levels of glucose, lactate, pyruvate, glutamate, glycerol, and the lactate/pyruvate ratio were unaltered by the NWT. Pathological SjvO2 (<50 % or >71 %; n = 2 NWTs) and PbtiO2 (<10 mmHg; n = 3 NWTs) values were rare at baseline and did not change following NWT. Finally, the NWT did not alter the AVD of glucose, lactate, or oxygen. CONCLUSIONS The NWT-induced stress response resulted in increased ICP and CPP levels although it did not negatively alter focal neurochemistry or cerebral oxygenation in TBI patients.
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Affiliation(s)
- Karin Skoglund
- Department of Neuroscience, Neurosurgery, Uppsala University Hospital, Uppsala University, 75185, Uppsala, Sweden
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Riviello JJ, Chang C. The practice of pediatric neurocritical care by the child neurologist. Semin Pediatr Neurol 2014; 21:299-302. [PMID: 25727512 DOI: 10.1016/j.spen.2014.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pediatric neurocritical care (NCC) has emerged as a defined subspecialty in child neurology and requires a collaborative effort among child neurologists, pediatric critical care medicine specialists, and pediatric neurosurgeons. Pediatric NCC has evolved differently in children than in adults, and its delivery depends on the local resources available for pediatric care. This article reviews the current practice of pediatric NCC by child neurologists: where it is practiced, how it is practiced, the disorders encountered (that differ from adult NCC), the training required to care for these disorders, and what is needed for the future of pediatric NCC.
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Affiliation(s)
- James J Riviello
- Morgan Stanley Children׳s Hospital of New York Presbyterian, New York, NY; The Queen׳s Medical Center, Honolulu, HI; Columbia College of Physicians and Surgeons, New York, NY; The University of Hawaii, Honolulu, HI.
| | - Cherylee Chang
- Morgan Stanley Children׳s Hospital of New York Presbyterian, New York, NY; The Queen׳s Medical Center, Honolulu, HI; Columbia College of Physicians and Surgeons, New York, NY; The University of Hawaii, Honolulu, HI
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30
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Abstract
Although neurocritical care as a subspecialty is a relatively young field of medicine, its origins can be traced back to ancient times. This article focuses on the progression of neurocritical care from prehistoric trepanation procedures, through the development of mechanical ventilation, management of increased intracranial pressure, and traumatic brain injury, to the establishment of the first "real" intensive care units, and finally to modern monitoring in neurocritical care, management of post-cardiac arrest patients, and the diagnosis of brain death. This article also focuses on the future direction of neurocritical care.
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Affiliation(s)
- Georgia Korbakis
- Department of Neurological Sciences, Rush University Medical Center, 600 South Paulina Street, Chicago, IL 60612, USA.
| | - Thomas Bleck
- Department of Neurological Sciences, Rush University Medical Center, 600 South Paulina Street, Chicago, IL 60612, USA; Department of Neurosurgery, Rush University Medical Center, 600 South Paulina Street, Chicago, IL 60612, USA; Department of Anesthesiology, Rush University Medical Center, 600 South Paulina Street, Chicago, IL 60612, USA; Department of Internal Medicine, Rush University Medical Center, 600 South Paulina Street, Chicago, IL 60612, USA
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31
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Improved outcome of patients with severe thalamic hemorrhage treated with cerebrospinal fluid drainage and neurocritical care during 1990-1994 and 2005-2009. Acta Neurochir (Wien) 2013; 155:2105-13. [PMID: 24026230 DOI: 10.1007/s00701-013-1871-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/31/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Patients with thalamic hemorrhage, depressed level of consciousness and/or signs of elevated intracranial pressure may be treated with neurocritical care (NCC) and external ventricular drainage (EVD) for release of cerebrospinal fluid. METHODS Forty-three patients with thalamic hemorrhage treated with NCC from 1990 to 1994 (n = 21) and from 2005-2009 (n = 22) were evaluated. Outcome was assessed using the Glasgow Coma Scale (GCS) score at discharge from our unit and the modified Rankin Scale (mRS) for long-term outcome. RESULTS Patients' age was 59.5 ± 7 years in 1990-1994, and 58.2 ± 9 years in 2005-2009. The median (25th and 75th percentile) GCS score on admission for the two time periods was 9 (6-12) and 9 (4-14), respectively. Long-term follow-up was assessed at a mean of 37.1 (range 19-65) months after disease onset for the 1990-1994 cohort and at 37.4 (range 14-58) months for the 2005-2009 cohort. Compared to patients from 1990 to 1994, patients from 2005 to 2009 had a significantly better outcome (median mRS [25th and 75th percentile]: 5 [4-6] vs. 4 [2-4.5]; p < 0.01). Most patients (13/21, 62 %) treated from 1990 to 1994 had unchanged or lower GCS scores during their NCC stay in contrast to 7/22 (32 %) from 2005 to 2009. At the last follow-up, 13/21 (62 %) patients from 1990 to 1994 were dead in comparison to 4/21 (19 %) from 2005 to 2009 (p < 0.05). Negative prognostic factors were the 120 h post-admission GCS score in the 1990-1994 patient cohort (p = 0.07) and high age in the recent cohort (p = 0.04). CONCLUSIONS Patients with thalamic hemorrhage and depressed level of consciousness on admission had a worse outcome in the early 1990s compared with the late 2000s, which may at least be partially attributed to refined neurocritical care.
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Rubiano AM, Puyana JC, Mock CN, Bullock MR, Adelson PD. Strengthening neurotrauma care systems in low and middle income countries. Brain Inj 2013; 27:262-72. [PMID: 23438347 DOI: 10.3109/02699052.2012.750742] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PRIMARY OBJECTIVE To review basic elements to be considered in the development of effective neurotrauma care systems in low- and middle-income countries. Neurotrauma occurs more frequently in developing countries. The survival rate among neurotrauma patients depends in large part on the degree of sophistication of the trauma system. RESEARCH DESIGN A critical review of the literature was undertaken. RESULTS In developing countries, there are difficulties in fully integrating the resources for care if the local and regional trauma systems are poorly structured. Factors like inadequate emergency and neurointensive care, low compensation compared with elective procedures or high medico-legal risks may result in a lack of interest from the few available neurosurgeons to be fully integrated in neurotrauma care. Appropriate structuring of trauma systems according to countries needs and their functionality is a key element that would facilitate the optimal use of resources for integral neurotrauma care. CONCLUSIONS In order to implement an efficient trauma system, organization of low cost resources such as trauma registries and quality control programmes are required. The participation of medical associations in legislative and government processes is also an important factor for the appropriate development and organization of an effective trauma system in under-privileged areas.
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Affiliation(s)
- Andres M Rubiano
- Trauma and Emergency Division, Neiva University Hospital, Neiva, Huila, Colombia.
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Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJB, Demaerschalk BM, Khatri P, McMullan PW, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44:870-947. [PMID: 23370205 DOI: 10.1161/str.0b013e318284056a] [Citation(s) in RCA: 3203] [Impact Index Per Article: 291.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. METHODS Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. RESULTS The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. CONCLUSIONS Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.
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Kim H, Kim JH. Evaluation of the clinical usefulness of critical patient severity classification system and glasgow coma scale for neurological patients in intensive care units. Asian Nurs Res (Korean Soc Nurs Sci) 2013; 7:8-15. [PMID: 25031210 DOI: 10.1016/j.anr.2013.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 09/18/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the clinical usefulness of the Critical Patient Severity Classification System (CPSCS) and Glasgow Coma Scale (GCS) for critically ill neurological patients and to determine the applicability of CPSCS and GCS in predicting their mortality. METHODS Data were collected from the medical records of 187 neurological patients who were admitted to the intensive care unit of C university hospital. The data were analyzed through chi-square test, t test, Mann-Whitney, Kruskal-Wallis, goodness-of-fit test, and receiver operating characteristic curve. RESULTS In accordance with patients' general and clinical characteristics, patient mortality turned out to be significantly different depending on intensive care unit stay, endotracheal intubation, central venous catheter, and severity by CPSCS. Hosmer-Lemeshow goodness-of-fit tests were applied to CPSCS and GCS. The results of the discrimination test using the receiver operating characteristic curve were CPSCS0, .743, GCS0 .583, CPSCS24, .734, GCS24 .612, CPSCS48, .591, GCS48 .646, CPSCS72, .622, and GCS72 .623. Logistic regression analysis showed that each point on the CPSCS score signifies a 1.034 higher likelihood of dying. CONCLUSION Applied to neurologically ill patients, early CPSCS scores can be regarded as a useful tool.
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Affiliation(s)
- Heejeong Kim
- Department of Nursing, Namseoul University, Chungcheongnam-do, South Korea.
| | - Jee Hee Kim
- Department of Emergency Medical Technology, Kangwon National University, Gangwon-do, South Korea
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Affiliation(s)
- L A Urbano
- Department of Critical Care Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
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Abstract
BACKGROUND Non-convulsive seizures have been reported to be common in neurocritical care patients. Many jurisdictions do not have sufficient resources to enable routine continuous electroencephalography (cEEG) and instead use primarily intermittent EEG, for which the diagnostic yield remains uncertain. Determining risk factors for epileptiform activity and seizures could help identify patients who might particularly benefit from EEG monitoring. METHODS We performed a cohort study involving neurocritical care patients with admission Glascow Coma Scale (GCS) scores ≤ 12, who underwent ≥ 1 EEG. EEGs were reviewed for presence of interictal discharges, periodic epileptiform discharges (PEDs), and seizures. Multivariate analysis was used to identify predictors of these findings and to describe their prognostic implications. RESULTS 393 patients met inclusion criteria. 34 underwent cEEG, usually because epileptiform activity was first detected on a routine EEG. The prevalence of PEDs or electrographic seizures was 13%, and was highest with anoxic encephalopathy and central nervous system infections. Other independent predictors for epileptiform activity included a history of convulsive seizure(s), increasing age, deeper coma, and female gender. Although patients with epileptiform activity had higher mortality, this association disappeared after adjustment for confounders. CONCLUSION Approximately 7-8 neurocritical care patients must undergo intermittent EEG monitoring in order to diagnose one with PEDs or seizures. The predictors we identified could potentially help guide use of resources. Repeated intermittent studies, or cEEG, should be considered in patients with multiple risk factors, or when interictal discharges are identified on an initial EEG. It remains unclear whether aggressive prevention and treatment of electrographic seizures improves neurologic outcomes.
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Dubost C, Motuel J, Geeraerts T. [Non-invasive evaluation of intracranial pressure: how and for whom?]. ACTA ACUST UNITED AC 2012; 31:e125-32. [PMID: 22683401 DOI: 10.1016/j.annfar.2012.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The invasive monitoring of intracranial pressure is useful in circumstances associated with high-risk of raised intracranial pressure. However the placement of intracranial probe is not always possible and non-invasive assessment of intracranial pressure may be useful, particularly in case of emergencies. Transcranial Doppler measurements allow the estimation of perfusion pressure with the pulsatility index. Recently, new ultrasonographic methods of cerebral monitoring have been developed: the diameter of the optic nerve sheath diameter, a surrogate marker of raised intracranial pressure and the estimation of median shift line deviation.
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Affiliation(s)
- C Dubost
- Département d'anesthésie-réanimation, HIA Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris 05, France
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Vahedi K, Proust F, Geeraerts T. [Experts' recommendations for stroke management in intensive care: intracranial hypertension]. Rev Neurol (Paris) 2012; 168:501-11. [PMID: 22571966 DOI: 10.1016/j.neurol.2011.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 04/29/2011] [Accepted: 07/19/2011] [Indexed: 11/20/2022]
Abstract
This article aims to describe the arguments underlying the experts' recommendations for management of stroke patients in the intensive unit, focusing on intracranial hypertension. This article describes the pathophysiology, diagnostic methods and therapeutic options for intracranial hypertension after stroke, including medical and surgical management.
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Affiliation(s)
- K Vahedi
- Service de neurologie, hôpital Lariboisière, 2 rue Ambroise-Paré, Paris, France
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Abstract
Neurocritical care is a subspecialty of critical care medicine, dedicated to the care and the advancement of care of critically ill patients with neurosurgical or neurological diseases. Neurocritical care patients are heterogeneous, in both their disease process and the therapies they receive, however, several studies demonstrate that care of these patients in dedicated NeuroIntensive Care Units (neuroICUs) by neurointensivists, who coordinate their care is associated with reduced mortality and resource utilization. NeuroICUs foster innovation, and yet despite all the recent advances, much research needs to be undertaken in neurocritical care to better understand the disease pathophysiology and to demonstrate improved outcome with the use of goal-directed therapy based on evolving techniques and therapies.
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de Carvalho FA, de Figueiredo MM, Silva GS. Acute Stroke: Postprocedural Care and Management of Complications. Tech Vasc Interv Radiol 2012; 15:78-86. [DOI: 10.1053/j.tvir.2011.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Indikationen und Outcome beatmeter Patienten einer neurologischen Intensivstation. DER NERVENARZT 2012; 83:741-50. [DOI: 10.1007/s00115-011-3411-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Amato A, Britz GW, James ML, Graffagnino C, Zomorodi AR, Zomorodi ME, Olson DM. An observational pilot study of CSF diversion in subarachnoid haemorrhage. Nurs Crit Care 2011; 16:252-60. [PMID: 21824230 DOI: 10.1111/j.1478-5153.2010.00444.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND A primary focus of hospital treatment following admission for subarachnoid haemorrhage (SAH) is a prevention of cerebral artery vasospasm, which may result in ischaemic stroke. Intraventricular catheter (IVC) insertion to facilitate cerebral spinal fluid (CSF) drainage and intracranial pressure (ICP) monitoring may reduce the incidence or severity of vasospasm, but insufficient evidence exists from which clinicians may determine the best practice of CSF management. AIMS The aim of this study was to provide the pilot data to explore the impact of different methods of CSF drainage on outcomes in patients with SAH. METHODS In this non-randomized observational study, patients diagnosed with SAH who had ICP monitoring in situ were prospectively enrolled. Group assignment was determined by the method of external ventricular drainage (EVD) management prescribed by the attending physician prior to enrollment. RESULTS The 37 subjects were disproportionately divided: open-EVD group (N = 24) and monitor-ICP group (N = 13). There were no statistically significant differences by group assignment with respect to vasospasm, length of stay (LOS), highest average ICP, total CSF drained and disability upon discharge between groups. CONCLUSIONS Although not significant, our results show that the monitor-ICP group trended towards improved clinical outcomes. These results provide sufficient equipoise to support further research in ICP management in patients with SAH using a randomized clinical trial. RELEVANCE TO CLINICAL PRACTICE This study provides a solid foundation for the development of a randomized trial exploring two different methods of ICP monitoring and CSF diversion during the acute phase of care following aneurysm rupture.
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Affiliation(s)
- Anthony Amato
- Neuroscience Critical Care Unit, Duke University Medical Center, Durham, NC, USA
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Association between out-of-hospital emergency department transfer and poor hospital outcome in critically ill stroke patients. J Crit Care 2011; 26:620-5. [DOI: 10.1016/j.jcrc.2011.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/16/2011] [Accepted: 02/20/2011] [Indexed: 11/22/2022]
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Kim H, Kim K. [Verification of validity of MPM II for neurological patients in intensive care units]. J Korean Acad Nurs 2011; 41:92-100. [PMID: 21516003 DOI: 10.4040/jkan.2011.41.1.92] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE Mortality Probability Model (MPM) II is a model for predicting mortality probability of patients admitted to ICU. This study was done to test the validity of MPM II for critically ill neurological patients and to determine applicability of MPM II in predicting mortality of neurological ICU patients. METHODS Data were collected from medical records of 187 neurological patients over 18 yr of age who were admitted to the ICU of C University Hospital during the period from January 2008 to May 2009. Collected data were analyzed through χ(2) test, t-test, Mann-Whiteny test, goodness of fit test, and ROC curve. RESULTS As to mortality according to patients' general and clinically related characteristics, mortality was statistically significantly different for ICU stay, hospital stay, APACHE III score, APACHE predicted death rate, GCS, endotracheal intubation, and central venous catheter. Results of Hosmer-Lemeshow goodness-of-fit test were MPM II(0) (χ(2)=0.02, p=.989), MPM II(24) (χ(2)=0.99 p=.805), MPM II(48) (χ(2)=0.91, p=.822), and MPM II(72) (χ(2)=1.57, p=.457), and results of the discrimination test using the ROC curve were MPM II(0), .726 (p<.001), MPM II(24), .764 (p<.001), MPM II(48), .762 (p<.001), and MPM II(72), .809 (p<.001). CONCLUSION MPM II was found to be a valid mortality prediction model for neurological ICU patients.
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Affiliation(s)
- Heejeong Kim
- Department of Nursing, Namseoul University, Cheonan, Korea
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Knecht S, Hesse S, Oster P. Rehabilitation after stroke. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:600-6. [PMID: 21966318 DOI: 10.3238/arztebl.2011.0600] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 03/21/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Stroke is becoming more common in Germany as the population ages. Its long-term sequelae can be alleviated by early reperfusion in stroke units and by complication management and functional restoration in early-rehabilitation and rehabilitation centers. METHODS Selective review of the literature. RESULTS Successful rehabilitation depends on systematic treatment by an interdisciplinary team of experienced specialists. In the area of functional restoration, there has been major progress in our understanding of the physiology of learning, relearning, training, and neuroenhancement. There have also been advances in supportive pharmacotherapy and robot technology. CONCLUSION Well-organized acute and intermediate rehabilitation after stroke can provide patients with the best functional results attainable on the basis of our current scientific understanding. Further experimental and clinical studies will be needed to expand our knowledge and improve the efficacy of rehabilitation.
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Bonifacio SL, Glass HC, Peloquin S, Ferriero DM. A new neurological focus in neonatal intensive care. Nat Rev Neurol 2011; 7:485-94. [PMID: 21808297 DOI: 10.1038/nrneurol.2011.119] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Advances in the care of high-risk newborn babies have contributed to reduced mortality rates for premature and term births, but the surviving neonates often have increased neurological morbidity. Therapies aimed at reducing the neurological sequelae of birth asphyxia at term have brought hypothermia treatment into the realm of standard care. However, this therapy does not provide complete protection from neurological complications and a need to develop adjunctive therapies for improved neurological outcomes remains. In addition, the care of neurologically impaired neonates, regardless of their gestational age, clearly requires a focused approach to avoid further injury to the brain and to optimize the neurodevelopmental status of the newborn baby at discharge from hospital. This focused approach includes, but is not limited to, monitoring of the patient's brain with amplitude-integrated and continuous video EEG, prevention of infection, developmentally appropriate care, and family support. Provision of dedicated neurocritical care to newborn babies requires a collaborative effort between neonatologists and neurologists, training in neonatal neurology for nurses and future generations of care providers, and the recognition that common neonatal medical problems and intensive care have an effect on the developing brain.
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Affiliation(s)
- Sonia L Bonifacio
- Department of Pediatrics, UCSF School of Medicine, UCSF Benioff Children's Hospital, Box 0410, 513 Parnassus Avenue, S211, San Francisco, CA 94143-0410, USA.
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Fuller G, Bouamra O, Woodford M, Jenks T, Patel H, Coats TJ, Oakley P, Mendelow A, Pigott T, Hutchinson PJ, Lecky F. Temporal trends in head injury outcomes from 2003 to 2009 in England and Wales. Br J Neurosurg 2011; 25:414-21. [DOI: 10.3109/02688697.2011.570882] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Meadows C, Rattenberry W, Waldmann C. Centralisation of Specialist Critical Care Services. J Intensive Care Soc 2011. [DOI: 10.1177/175114371101200202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Chris Meadows
- Cardiothoracic Anaesthesia Fellow, Royal Brompton Hospital
| | | | - Carl Waldmann
- Consultant in Intensive Care and Anaesthesia, Royal Berkshire Hospital Reading
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Teig M, Smith M. Where should patients with severe traumatic brain injury be managed? All patient should be managed in a neurocritical care unit. J Neurosurg Anesthesiol 2011; 22:357-9. [PMID: 20844380 DOI: 10.1097/ana.0b013e3181f0dada] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Geeraerts T, Menon D. Le monitorage de la pression intracrânienne améliore-t-il le devenir des traumatisés crâniens graves ? ACTA ACUST UNITED AC 2010; 29:e171-5. [DOI: 10.1016/j.annfar.2010.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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