Mechanical ventilation in neurocritical care setting: A clinical approach

The relationship between tracheostomy and dysphagia remains controversial. Many centers require swallow evaluations for all patients after tracheostomy because of the assumed increased rate of dysphagia and aspiration that they are thought to promote. Tracheostomies are now most commonly placed in the intensive care setting in adult patients with polytrauma or severe medical illness who are on mechanical ventilation. While tracheostomy and dysphagia often coexist in this population, they may not be directly related, as physiologic alterations observed in tracheostomized patients have not demonstrably translated into clinically significant complications of dysphagia. Instead, there is growing evidence that chronicity and severity of underlying illness, comorbidities, and recent intubation are the major arbiters of dysphagia in patient population. This brief report reviews the literature investigating the association between tracheostomy and dysphagia in adults, and discusses the role that illness severity, comorbidity, and intubation play in dysphagia etiology and how they confound the tracheostomy-dysphagia relationship.

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DEVELOPMENT OF NEUROCRITICAL CARE

Annals of the Russian academy of medical sciences ◽

10.15690/vramn.v67i9.403 ◽

2012 ◽

Vol 67 (9) ◽

pp. 27-30 ◽

Cited By ~ 1

Author(s):

M. A. Piradov ◽

V. V. Moroz

Keyword(s):

Mechanical Ventilation ◽

Neurocritical Care ◽

Vegetative State ◽

Persistent Vegetative State ◽

Multiple Organ ◽

Walking Ability ◽

Severe Stroke ◽

History Of ◽

Further Development ◽

Goals And Objectives

In this review we provide the definition, goals and objectives of neurocritical care, evaluation of brief history of its development. Mechanical ventilation, intracranial hypertension, neuromonitoring as underlying basics of neurocritical care approaches are discussed. The main types of pathology and specific methods used in neurocritical care units are discussed. The results of our own research on brain death — the development of national criteria; for Guillain-Barre syndrome — a double decrease in the length of mechanical ventilation and in 2.5 times of the recovery time for independent walking ability; on diphteric polyneuropathy — reduced by 11 times mortality compared with nation-wide indicators of non-traumatic persistent vegetative state — the development of diagnostic and predictive neurophysiologic criteria are demonstrated. Research data of multiple organ disfunction syndrome in severe stroke are described. Further development of neurocritical care is being discussed.

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Mechanical Ventilation in Neurocritical Patients

10.5772/intechopen.101029 ◽

2021 ◽

Author(s):

Thierry Hernández-Gilsoul ◽

Jose de Jesús Vidal-Mayo ◽

Alan Alexis Chacon-Corral

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Intracranial Pressure ◽

Prone Position ◽

Neurocritical Care ◽

Lung Ventilation ◽

Permissive Hypercapnia ◽

Airway Protection ◽

Protective Lung Ventilation

Patients under neurocritical care may require mechanical ventilation for airway protection; respiratory failure can occur simultaneously or be acquired during the ICU stay. In this chapter, we will address the ventilatory strategies, in particular the role of protective lung ventilation, and the potential increase in intracranial pressure as a result of permissive hypercapnia, high airway pressures during recruitment maneuvers, and/or prone position. We will also describe some strategies to achieve mechanical ventilation liberation, including evaluation for tracheostomy, timing of tracheostomy, mechanical ventilation modalities for weaning and extubation, or tracheostomy weaning for mechanical ventilation.

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Heparin-Induced Fever in Neurointensive Care Unit: A Rarity Yet a Possibility

Journal of Neuroanaesthesiology and Critical Care ◽

10.1055/s-0041-1739350 ◽

2021 ◽

Author(s):

Mathangi Krishnakumar ◽

Shweta S. Naik ◽

Venkatapura J. Ramesh ◽

S Mouleeswaran

Keyword(s):

Care Setting ◽

Neurocritical Care ◽

Secondary Brain Injury ◽

Protective Response ◽

Inflammatory Cascade ◽

Persistent Fever ◽

Neurointensive Care Unit ◽

Injured Tissue ◽

Injured Brain ◽

Resistance To Infection

AbstractFever is considered a protective response having multitude of benefits in terms of enhancing resistance to infection, recruiting cytokines to the injured tissue, and promoting healing. In terms of an injured brain, this becomes a double-edged sword triggering an inflammatory cascade resulting in secondary brain injury. It is important to identify the etiology so that corrective measures can be taken. Here we report a case of persistent fever in a patient with Guillain-Barré syndrome, which was probably due to heparin. This is the first report of heparin-induced fever in a neurocritical care setting and third report overall.

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S18-1. Electroencephalography (EEG) in the neurocritical care setting

Clinical Neurophysiology ◽

10.1016/j.clinph.2019.06.143 ◽

2019 ◽

Vol 130 (10) ◽

pp. e204

Author(s):

Yuichi Kubota

Keyword(s):

Care Setting ◽

Neurocritical Care

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Sensitivity of a Reduced EEG Montage for Seizure Detection in the Neurocritical Care Setting

Journal of Clinical Neurophysiology ◽

10.1097/wnp.0000000000000463 ◽

2018 ◽

Vol 35 (3) ◽

pp. 256-262 ◽

Cited By ~ 4

Author(s):

Brandy B. Ma ◽

Emily L. Johnson ◽

Eva K. Ritzl

Keyword(s):

Care Setting ◽

Neurocritical Care ◽

Seizure Detection

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Music in mechanically ventilated stroke patients

British Journal of Neuroscience Nursing ◽

10.12968/bjnn.2019.15.sup5.s8 ◽

2019 ◽

Vol 15 (Sup5) ◽

pp. S8-S13

Author(s):

DaiWai M Olson ◽

Anjali Perera ◽

Folefac Atem ◽

Audra S Wagner ◽

Michael Zanders ◽

...

Keyword(s):

Critical Care ◽

Pilot Study ◽

Stress Reduction ◽

Care Setting ◽

Neurocritical Care ◽

Stroke Patients ◽

Mechanically Ventilated ◽

Significant Difference ◽

Pilot Intervention ◽

Route Of Delivery

Background: Music as a therapeutic intervention for critically ill stroke patients has not been adequately researched. This may be related to a limited number of tools being available to measure the hypnotic response when patients cannot respond verbally. This pilot study examines the feasibility of bispectral index (BIS) monitoring to study music as a stress-reduction intervention in the neurocritical care setting. Methods: This prospective, randomised, crossover, pilot study enrolled 30 patients. On each of two consecutive days, patients were randomised to either 1 hour of silence followed by a crossover to 1 hour of music, or the reverse (music then silence). BIS values were recorded to evaluate stress and agitation before, during and after the 2-hour study period. Results: There were no reported adverse events, supporting feasibility of this pilot intervention. BIS values were sampled once every 6 seconds during the 2-hour study period. There was a statistically significant difference in BIS scores between the music and no music group (p<0.0001). Conclusion: The use of neurofunction monitors to assess response to music is feasible during the critical care phase for patients with stroke. Additional studies should focus on genre, timing and route of delivery for music as an intervention.

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