1
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Chang CWJ. Seeking Harmony-Determining Brain Death/Death by Neurologic Criteria Circa 2023. Crit Care Med 2024; 52:495-497. [PMID: 38381009 DOI: 10.1097/ccm.0000000000006127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
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2
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Kaplan LJ, Bailey H, Pascual J, Chang CWJ, Cerra F. In Search of Clarity. Crit Care Med 2024; 52:343-345. [PMID: 38240515 DOI: 10.1097/ccm.0000000000005998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Heatherlee Bailey
- Department of Emergency Medicine, Durham VA Medical Center, Durham, NC
| | - Jose Pascual
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Frank Cerra
- Department of Surgery, University of Minnesota, Minneapolis, MN
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Wall AE, Adams BL, Brubaker A, Chang CWJ, Croome KP, Frontera J, Gordon E, Hoffman J, Kaplan LJ, Kumar D, Levisky J, Miñambres E, Parent B, Watson C, Zemmar A, Pomfret EA. The American Society of Transplant Surgeons Consensus Statement on Normothermic Regional Perfusion. Transplantation 2024; 108:312-318. [PMID: 38254280 DOI: 10.1097/tp.0000000000004894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
On June 3, 2023, the American Society of Transplant Surgeons convened a meeting in San Diego, California to (1) develop a consensus statement with supporting data on the ethical tenets of thoracoabdominal normothermic regional perfusion (NRP) and abdominal NRP; (2) provide guidelines for the standards of practice that should govern thoracoabdominal NRP and abdominal NRP; and (3) develop and implement a central database for the collection of NRP donor and recipient data in the United States. National and international leaders in the fields of neuroscience, transplantation, critical care, NRP, Organ Procurement Organizations, transplant centers, and donor families participated. The conference was designed to focus on the controversial issues of neurological flow and function in donation after circulatory death donors during NRP and propose technical standards necessary to ensure that this procedure is performed safely and effectively. This article discusses major topics and conclusions addressed at the meeting.
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Affiliation(s)
- Anji E Wall
- Division of Abdominal Transplantation, Baylor Simmons Transplant Institute, Dallas, TX
| | | | - Aleah Brubaker
- Department of Surgery, University of California San Diego, San Diego, CA
| | - Cherylee W J Chang
- Neurocritical Care Division, Department of Neurology, Duke University, Durham, NC
| | | | - Jennifer Frontera
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
| | - Elisa Gordon
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jordan Hoffman
- Heart and Lung Transplantation and CTEPH Program, University of Colorado School of Medicine, Anschutz Medical Campus, Denver, CO
| | - Lewis J Kaplan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Surgical Critical Care Section, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Deepali Kumar
- Transplant Infectious Diseases, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Josh Levisky
- Division of Hepatology, Department of Medicine, Northwestern Medicine, Chicago, IL
| | - Eduardo Miñambres
- Donor Transplant Coordination Unit and Intensive Care Service, Hospital Universitario de Marqués de Valdecilla-IDIVAL, Spain
| | - Brendan Parent
- Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY
| | - Christopher Watson
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | - Ajmal Zemmar
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | - Elizabeth A Pomfret
- Division of Transplant Surgery and Colorado Center for Transplantation Care, Research and Education (CCTCARE), University of Colorado Anschutz Medical Campus, Denver, CO
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Bass GA, Chang CWJ, Winkle JM, Cecconi M, Kudchadkar SR, Akuamoah-Boateng K, Einav S, Duffy CC, Hidalgo J, Rodriquez-Vega GM, Gandra-d'Almeida AJ, Barletta JF, Kaplan LJ. Concise Definitive Review: In-Hospital Violence and Its Impact on Critical Care Practitioners. Crit Care Med 2024:00003246-990000000-00273. [PMID: 38236075 DOI: 10.1097/ccm.0000000000006189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
OBJECTIVES To provide a narrative review of hospital violence (HV) and its impact on critical care clinicians. DATA SOURCES Detailed search strategy using PubMed and OVID Medline for English language articles describing HV, risk factors, precipitating events, consequences, and mitigation strategies. STUDY SELECTION Studies that specifically addressed HV involving critical care medicine clinicians or their practice settings were selected. The time frame was limited to the last 15 years to enhance relevance to current practice. DATA EXTRACTION Relevant descriptions or studies were reviewed, and abstracted data were parsed by setting, clinician type, location, social media events, impact, outcomes, and responses (agency, facility, health system, individual). DATA SYNTHESIS HV is globally prevalent, especially in complex care environments, and correlates with a variety of factors including ICU stay duration, conflict, and has recently expanded to out-of-hospital occurrences; online violence as well as stalking is increasingly prevalent. An overlap with violent extremism and terrorism that impacts healthcare facilities and clinicians is similarly relevant. A number of approaches can reduce HV occurrence including, most notably, conflict management training, communication initiatives, and visitor flow and access management practices. Rescue training for HV occurrences seems prudent. CONCLUSIONS HV is a global problem that impacts clinicians and imperils patient care. Specific initiatives to reduce HV drivers include individual training and system-wide adaptations. Future methods to identify potential perpetrators may leverage machine learning/augmented intelligence approaches.
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Affiliation(s)
- Gary A Bass
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Julie M Winkle
- Emergency Medicine, UC Health, University of Colorado Hospital, Aurora, CO
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD
| | - Kwame Akuamoah-Boateng
- Department of Surgery Acute Care Surgical Services, Mary Baldwin University and Virginia Commonwealth University Health Richmond, Richmond, VA
| | - Sharon Einav
- General Intensive Care Unit of the Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University School of Medicine, Jerusalem, Israel
| | - Caoimhe C Duffy
- Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jorge Hidalgo
- Division of Critical Care, Karl Heusner Memorial Hospital, Belize City, Belize
| | - Gloria M Rodriquez-Vega
- Department of Critical Care Medicine - HIMA-San Pablo, Caguas Puerto Rico
- University of Puerto Rico, School of Medicine, Caguas, Puerto Rico
| | | | - Jeffrey F Barletta
- Pharmacy Practice, Midwestern University, College of Pharmacy-Glendale Campus, Glendale, AZ
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Bass GA, Chang CWJ, Sorce LR, Subramanian S, Laytin AD, Somodi R, Gray JR, Lane-Fall M, Kaplan LJ. Gamification in Critical Care Education and Practice. Crit Care Explor 2024; 6:e1034. [PMID: 38259864 PMCID: PMC10803028 DOI: 10.1097/cce.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES To explore gamification as an alternative approach to healthcare education and its potential applications to critical care. DATA SOURCES English language manuscripts addressing: 1) gamification theory and application in healthcare and critical care and 2) implementation science focused on the knowledge-to-practice gap were identified in Medline and PubMed databases (inception to 2023). STUDY SELECTION Studies delineating gamification underpinnings, application in education or procedural mentoring, utilization for healthcare or critical care education and practice, and analyses of benefits or pitfalls in comparison to other educational or behavioral modification approaches. DATA EXTRACTION Data indicated the key gamification tenets and the venues within which they were used to enhance knowledge, support continuing medical education, teach procedural skills, enhance decision-making, or modify behavior. DATA SYNTHESIS Gamification engages learners in a visual and cognitive fashion using competitive approaches to enhance acquiring new knowledge or skills. While gamification may be used in a variety of settings, specific design elements may relate to the learning environment or learner styles. Additionally, solo and group gamification approaches demonstrate success and leverage adult learning theory elements in a low-stress and low-risk setting. The potential for gamification-driven behavioral modification to close the knowledge-to-practice gap and enable guideline and protocol compliance remains underutilized. CONCLUSIONS Gamification offers the potential to substantially enhance how critical care professionals acquire and then implement new knowledge in a fashion that is more engaging and rewarding than traditional approaches. Accordingly, educational undertakings from courses to offerings at medical professional meetings may benefit from being gamified.
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Affiliation(s)
- Gary Alan Bass
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Lauren R Sorce
- Department of Pediatrics (Critical Care), Northwestern University, Chicago, IL
| | - Sanjay Subramanian
- Department of Anesthesiology, Critical Care Medicine, Washington University in St. Louis, St. Louis, MO
- Omnicure Inc., St. Louis, MO
| | - Adam D Laytin
- Departments of Anesthesia and Critical Care Medicine and Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Reka Somodi
- Section of Surgical Critical Care, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Jaime R Gray
- Department of Pharmacy, Temple University Health System, Philadelphia, PA
| | - Meghan Lane-Fall
- Departments of Anesthesiology and Critical Care Medicine and Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Chang CWJ, Kaplan LJ. The authors reply. Crit Care Med 2023; 51:e248-e249. [PMID: 37902357 DOI: 10.1097/ccm.0000000000005996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- Cherylee W J Chang
- Division of Neurocritical Care, Department of Neurology, Duke University School of Medicine, Durham, NC
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Chang CWJ, Provencio JJ, Pascual J, Heavner MS, Olson D, Livesay SL, Kaplan LJ. State-of-the-Art Evaluation of Acute Adult Disorders of Consciousness for the General Intensivist. Crit Care Med 2023; 51:948-963. [PMID: 37070819 DOI: 10.1097/ccm.0000000000005893] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVES To provide a concise review of knowledge and practice pertaining to the diagnosis and initial management of unanticipated adult patient disorders of consciousness (DoC) by the general intensivist. DATA SOURCES Detailed search strategy using PubMed and OVID Medline for English language articles describing adult patient acute DoC diagnostic evaluation and initial management strategies including indications for transfer. STUDY SELECTION Descriptive and interventional studies that address acute adult DoC, their evaluation and initial management, indications for transfer, as well as outcome prognostication. DATA EXTRACTION Relevant descriptions or studies were reviewed, and the following aspects of each manuscript were identified, abstracted, and analyzed: setting, study population, aims, methods, results, and relevant implications for adult critical care practice. DATA SYNTHESIS Acute adult DoC may be categorized by etiology including structural, functional, infectious, inflammatory, and pharmacologic, the understanding of which drives diagnostic investigation, monitoring, acute therapy, and subsequent specialist care decisions including team-based local care as well as intra- and inter-facility transfer. CONCLUSIONS Acute adult DoC may be initially comprehensively addressed by the general intensivist using an etiology-driven and team-based approach. Certain clinical conditions, procedural expertise needs, or resource limitations inform transfer decision-making within a complex care facility or to one with greater complexity. Emerging collaborative science helps improve our current knowledge of acute DoC to better align therapies with underpinning etiologies.
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Affiliation(s)
| | | | - Jose Pascual
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mojdeh S Heavner
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - DaiWai Olson
- Departments of Neurology and Neurosurgery, University of Texas Southwestern, Dallas, TX
| | - Sarah L Livesay
- Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University, Chicago, IL
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Mac Grory B, Holmes DN, Matsouaka RA, Shah S, Chang CWJ, Rison R, Jindal J, Holmstedt C, Logan WR, Corral C, Mackey JS, Gee JR, Bonovich D, Walker J, Gropen T, Benesch C, Dissin J, Pandey H, Wang D, Unverdorben M, Hernandez AF, Reeves M, Smith EE, Schwamm LH, Bhatt DL, Saver JL, Fonarow GC, Peterson ED, Xian Y. Recent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke. JAMA 2023; 329:2038-2049. [PMID: 37338878 PMCID: PMC10282891 DOI: 10.1001/jama.2023.8073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/25/2023] [Indexed: 06/21/2023]
Abstract
Importance Use of oral vitamin K antagonists (VKAs) may place patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke caused by large vessel occlusion at increased risk of complications. Objective To determine the association between recent use of a VKA and outcomes among patients selected to undergo EVT in clinical practice. Design, Setting, and Participants Retrospective, observational cohort study based on the American Heart Association's Get With the Guidelines-Stroke Program between October 2015 and March 2020. From 594 participating hospitals in the US, 32 715 patients with acute ischemic stroke selected to undergo EVT within 6 hours of time last known to be well were included. Exposure VKA use within the 7 days prior to hospital arrival. Main Outcome and Measures The primary end point was symptomatic intracranial hemorrhage (sICH). Secondary end points included life-threatening systemic hemorrhage, another serious complication, any complications of reperfusion therapy, in-hospital mortality, and in-hospital mortality or discharge to hospice. Results Of 32 715 patients (median age, 72 years; 50.7% female), 3087 (9.4%) had used a VKA (median international normalized ratio [INR], 1.5 [IQR, 1.2-1.9]) and 29 628 had not used a VKA prior to hospital presentation. Overall, prior VKA use was not significantly associated with an increased risk of sICH (211/3087 patients [6.8%] taking a VKA compared with 1904/29 628 patients [6.4%] not taking a VKA; adjusted odds ratio [OR], 1.12 [95% CI, 0.94-1.35]; adjusted risk difference, 0.69% [95% CI, -0.39% to 1.77%]). Among 830 patients taking a VKA with an INR greater than 1.7, sICH risk was significantly higher than in those not taking a VKA (8.3% vs 6.4%; adjusted OR, 1.88 [95% CI, 1.33-2.65]; adjusted risk difference, 4.03% [95% CI, 1.53%-6.53%]), while those with an INR of 1.7 or lower (n = 1585) had no significant difference in the risk of sICH (6.7% vs 6.4%; adjusted OR, 1.24 [95% CI, 0.87-1.76]; adjusted risk difference, 1.13% [95% CI, -0.79% to 3.04%]). Of 5 prespecified secondary end points, none showed a significant difference across VKA-exposed vs VKA-unexposed groups. Conclusions and Relevance Among patients with acute ischemic stroke selected to receive EVT, VKA use within the preceding 7 days was not associated with a significantly increased risk of sICH overall. However, recent VKA use with a presenting INR greater than 1.7 was associated with a significantly increased risk of sICH compared with no use of anticoagulants.
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Affiliation(s)
- Brian Mac Grory
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Roland A. Matsouaka
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Shreyansh Shah
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina
| | - Cherylee W. J. Chang
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina
| | - Richard Rison
- Department of Neurology, USC Keck School of Medicine, Los Angeles, California
| | - Jenelle Jindal
- Department of Neurology, Peter C. Fung, MD, Stroke Center, El Camino Hospital, Mountain View, California
| | | | - William R. Logan
- Department of Neurology, Mercy Hospital of St Louis, St Louis, Missouri
| | - Candy Corral
- Department of Neurology, Huntington Memorial Hospital, Pasadena, California
| | - Jason S. Mackey
- Department of Neurology, Indiana University School of Medicine, Indianapolis
| | - Joey R. Gee
- Department of Neurology, St Joseph’s Heritage Medical Group, Irvine, California
| | - David Bonovich
- Department of Neurology, Sutter Health, Castro Valley, California
| | - James Walker
- Department of Anesthesiology, Critical Care, and Neurocritical Care, Ascension Via Christi Hospital and University of Kansas School of Medicine, Wichita
| | - Toby Gropen
- Department of Neurology, University of Alabama School of Medicine, Birmingham
| | - Curtis Benesch
- Department of Neurology, University of Rochester School of Medicine, Rochester, New York
| | - Jonathan Dissin
- Department of Neurology, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Hemant Pandey
- Department of Neurology, Banner Baywood Medical Center, Chandler, Arizona
| | - David Wang
- Department of Neurology, OSF Healthcare, Peoria, Illinois
| | - Martin Unverdorben
- Global Specialty Medical Affairs, Daiichi Sankyo Inc, Basking Ridge, New Jersey
| | - Adrian F. Hernandez
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Mathew Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing
| | - Eric E. Smith
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston
- Yale School of Medicine, New Haven, Connecticut
| | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New Nork, New York
| | | | - Gregg C. Fonarow
- Department of Medicine, University of California, Los Angeles
- Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, California
| | - Eric D. Peterson
- Department of Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Ying Xian
- Department of Neurology, UT Southwestern Medical Center, Dallas, Texas
- Department of Population and Data Science, UT Southwestern Medical Center, Dallas, Texas
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Bleck TP, Buchman TG, Chang CWJ, Dellinger RP, Deutschman CS, Kadri SS, Marshall JC, Maslove DM, Masur H, Osborn TM, Parker MM, Rochwerg B, Sarwal A, Sevransky J, Thiagarajan RR. The authors reply. Crit Care Med 2022; 50:e604-e606. [PMID: 35612454 DOI: 10.1097/ccm.0000000000005529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Timothy G Buchman
- Founding Director (Emeritus), Emory Critical Care Center; Medical Director, Emory eICU Center; Professor of Surgery, Anesthesiology, and Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
| | - Cherylee W J Chang
- Division Chief, Neurocritical Care, Professor of Neurology, Duke University School of Medicine, Durham, NC
| | | | | | | | | | - David M Maslove
- Associate Professor, Departments of Medicine and Critical Care Medicine, Queen's University & Kingston Health Sciences Centre, Kingston, ON, Canada
| | | | - Tiffany M Osborn
- Associate Professor, Department of Surgery and Division of Emergency Medicine, Section of Acute and Critical Care Surgery, Surgical/Trauma Critical Care, Barnes Jewish Hospital Washington University, St. Louis, MO
| | | | | | | | | | - Ravi R Thiagarajan
- Chief, Cardiac Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, MA
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Kaplan L, Moheet AM, Livesay SL, Provencio JJ, Suarez JI, Bader MK, Bailey H, Chang CWJ. A Perspective from the Neurocritical Care Society and the Society of Critical Care Medicine: Team-Based Care for Neurological Critical Illness. Neurocrit Care 2021; 32:369-372. [PMID: 32043264 DOI: 10.1007/s12028-020-00927-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Neurocritical Care Society and the Society of Critical Care Medicine have worked together to create a perspective regarding the Standards of Neurologic Critical Care Units (Moheet et al. in Neurocrit Care 29:145-160, 2018). The most neurologically ill or injured patients warrant the highest standard of care available; this supports the need for defining and establishing specialized neurological critical care units. Rather than interpreting the Standards as being exclusionary, it is most appropriate to embrace them in the setting of team-based care. Since there are many more patients than there are highly specialized beds, collaborative care and appropriate transfer agreements are essential in promoting excellent patient outcomes. This viewpoint addresses areas of clarification and emphasizes the need for collegiality and partnership in delivering the best specialty critical care to our patients.
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Affiliation(s)
- Lewis Kaplan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Asma M Moheet
- OhioHealth Riverside Methodist Hospital, Columbus, OH, USA
| | | | | | | | | | | | - Cherylee W J Chang
- Neuroscience Institute/Neurocritical Care, The Queen's Medical Center Neuroscience Institute, Honolulu, HI, 96813, USA.
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
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Moheet AM, Livesay SL, Abdelhak T, Bleck TP, Human T, Karanjia N, Lamer-Rosen A, Medow J, Nyquist PA, Rosengart A, Smith W, Torbey MT, Chang CWJ. Standards for Neurologic Critical Care Units: A Statement for Healthcare Professionals from The Neurocritical Care Society. Neurocrit Care 2019; 29:145-160. [PMID: 30251072 DOI: 10.1007/s12028-018-0601-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Neurocritical care is a distinct subspecialty focusing on the optimal management of acutely ill patients with life-threatening neurologic and neurosurgical disease or with life-threatening neurologic manifestations of systemic disease. Care by expert healthcare providers to optimize neurologic recovery is necessary. Given the lack of an organizational framework and criteria for the development and maintenance of neurological critical care units (NCCUs), this document is put forth by the Neurocritical Care Society (NCS). Recommended organizational structure, personnel and processes necessary to develop a successful neurocritical care program are outlined. Methods: Under the direction of NCS Executive Leadership, a multidisciplinary writing group of NCS members was formed. After an iterative process, a framework was proposed and approved by members of the writing group. A draft was then written, which was reviewed by the NCS Quality Committee and NCS Guidelines Committee, members at large, and posted for public comment. Feedback was formally collated, reviewed and incorporated into the final document which was subsequently approved by the NCS Board of Directors.
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Affiliation(s)
| | | | | | | | | | | | | | - Joshua Medow
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | | | - Wade Smith
- University of California, San Francisco, San Francisco, CA, USA
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Moheet AM, Livesay SL, Abdelhak T, Bleck TP, Human T, Karanjia N, Lamer-Rosen A, Medow J, Nyquist PA, Rosengart A, Smith W, Torbey MT, Chang CWJ. Correction to: Standards for Neurologic Critical Care Units: A Statement for Healthcare Professionals from The Neurocritical Care Society. Neurocrit Care 2019; 31:229. [PMID: 31119686 DOI: 10.1007/s12028-019-00721-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The authors note that there is a discrepancy between the text of the paper and Table 2 regarding physician subspecialty certification requirements in neurocritical care for Level II centers.
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Affiliation(s)
- Asma M Moheet
- OhioHealth Riverside Methodist Hospital, Columbus, OH, USA.
| | | | | | | | | | | | | | - Joshua Medow
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | | | - Wade Smith
- University of California, San Francisco, San Francisco, CA, USA
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Chang CWJ. The discovery, recognition, and rebirth of a specialty. Crit Care Clin 2014; 30:ix-x. [PMID: 25257744 DOI: 10.1016/j.ccc.2014.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Cherylee W J Chang
- Neuroscience Institute/Neurocritical Care, Stroke Center, The Queen's Medical Center, John A. Burns School of Medicine, University of Hawaii, 1301 Punchbowl Street, QET5, Honolulu, HI 96813, USA.
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Nakagawa K, Vento MA, Seto TB, Koenig MA, Asai SM, Chang CWJ, Hemphill JC. Sex differences in the use of early do-not-resuscitate orders after intracerebral hemorrhage. Stroke 2013; 44:3229-31. [PMID: 23982712 DOI: 10.1161/strokeaha.113.002814] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Studies show that women are more likely to receive do-not-resuscitate (DNR) orders after acute medical illnesses than men. However, the sex differences in the use of DNR orders after acute intracerebral hemorrhage (ICH) have not been described. METHODS We conducted a retrospective study of consecutive patients hospitalized for acute ICH at a tertiary stroke center between 2006 and 2010. Unadjusted and multivariable logistic regression analyses were performed to test for associations between female sex and early (<24 hours of presentation) DNR orders. RESULTS A total of 372 consecutive ICH patients without preexisting DNR orders were studied. Overall, 82 (22%) patients had early DNR orders after being hospitalized with ICH. In the fully adjusted model, early DNR orders were more likely in women (odds ratio, 3.18; 95% confidence interval, 1.51-6.70), higher age (odds ratio, 1.09 per year; 95% confidence interval, 1.05-1.12), larger ICH volume (odds ratio, 1.01 per cm(3); 95% confidence interval, 1.01-1.02), and lower initial GCS score (odds ratio, 0.76 per point; 95% confidence interval, 0.69-0.84). Early DNR orders were less likely when the patients were transferred from another hospital (odds ratio, 0.28, 95% confidence interval, 0.11-0.76). CONCLUSIONS Women are more likely to receive early DNR orders after ICH than men. Further prospective studies are needed to determine factors contributing to the sex variation in the use of early DNR order after ICH.
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Affiliation(s)
- Kazuma Nakagawa
- From The Queen's Medical Center, Honolulu, HI (K.N., M.A.V., T.B.S., M.A.K., S.M.A., C.W.J.C.); Departments of Medicine (K.N., T.B.S., M.A.K., C.W.J.C.), Native Hawaiian Health (T.B.S.), and Surgery (C.W.J.C.), John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; and the Department of Neurology and Neurosurgery, University of California, San Francisco, CA (J.C.H.)
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Green DM, O'Phelan KH, Bassin SL, Chang CWJ, Stern TS, Asai SM. Intensive versus conventional insulin therapy in critically ill neurologic patients. Neurocrit Care 2011; 13:299-306. [PMID: 20697836 DOI: 10.1007/s12028-010-9417-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Previous studies of glycemic control in non-neurologic ICU patients have shown conflicting results. The purpose was to investigate whether intensive insulin therapy (IIT) to keep blood glucose levels from 80 to 110 mg/dl or conventional treatment to keep levels less than 151 mg/dl was associated with a reduction of mortality and improved functional outcome in critically ill neurologic patients. METHODS Within 24 h of ICU admission, mechanically ventilated adult neurologic patients were enrolled after written informed consent and randomized to intensive or conventional control of blood glucose levels with insulin. Primary outcome measure was death within 3 months. Secondary outcome measures included 90-day modified Rankin scale (mRS) score, ICU, and hospital LOS. RESULTS 81 patients were enrolled. The proportion of deaths was higher among IIT patients but this was not statistically significant (36 vs. 25%, P = 0.34). When good versus poor outcome at 3 months was dichotomized to mRS score 0-2 versus 3-6, respectively, there was no difference in outcome between the two groups (76.2 vs. 75% had a poor 3-month outcome, P = 1.0). There was also no difference in ICU or hospital LOS. Hypoglycemia (<60 mg/dl) and severe hypoglycemia (<40 mg/dl) were more common in the intensive arm (48 vs. 11%, P = 0.0006; and 4 vs. 0%, P = 0.5, respectively). CONCLUSION There was no benefit to IIT in this small critically ill neurologic population. This is the first glycemic control study to specifically examine both critically ill stroke and traumatic brain injury (TBI) patients and functional outcome. Given these results, IIT cannot be recommended over conventional control.
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O'Phelan KH, Park D, Efird JT, Johnson K, Albano M, Beniga J, Green DM, Chang CWJ. Patterns of increased intracranial pressure after severe traumatic brain injury. Neurocrit Care 2009; 10:280-6. [PMID: 19165634 DOI: 10.1007/s12028-008-9183-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 12/17/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Secondary brain injury due to increased intracranial pressure (ICP) contributes to post-traumatic morbidity and mortality. Although it is often taught that increased ICP begins early after traumatic brain injury, some patients develop increased ICP after the first 3 days post-injury. We examined our data to describe temporal patterns of increased ICP. METHODS This is a retrospective review of prospectively collected physiologic and demographic data. RESULTS Seventy-seven patients were included. We identified four patterns of increased ICP: beginning within 72 h (early), beginning after 72 h (late), early increases with resolution, and then a second rise after 72 h (bimodal), and continuously increased ICP. Late increases in ICP occur in 17% of this cohort. Peak day of swelling was day 7 for the "late" rise group and day 4 for the other patients with increased ICP. Forty-four percent of patients showed enlargement of cerebral contusions on follow-up imaging at 24 h post-injury. CONCLUSIONS Late rises in ICP were not rare in this cohort. This is clinically relevant as it may impact decisions about ICP monitor removal. Differences between groups in age, CT patterns of injury, fluid therapy, osmotic use, and fever were not statistically significant.
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