P109 Experience of tunnelled vs. bolt EVDs on the intensive care unit

2019 ◽  
Vol 90 (3) ◽  
pp. e50.4-e51
Author(s):  
H Asif ◽  
CL Craven ◽  
U Reddy ◽  
LD Watkins ◽  
AK Toma
Keyword(s):  
Intensive Care Unit ◽  
External Ventricular Drain ◽  
Complication Rates ◽  
Single Centre ◽  
Acute Hydrocephalus ◽  
Clinical Notes ◽  
Before And After ◽  
Csf Diversion ◽  
Neurosurgical Operation ◽  
Mean Time

ObjectivesThe placement of an external ventricular drain (EVD) is a common neurosurgical operation that carries great benefit in acute hydrocephalus but is not without risk. In our centre, bolt EVDs (B-EVD) are being placed in favour of tunnelled EVDs (T-EVD). The former has allowed for urgent CSF diversion in ITU. We compared EVD survival and complication rates between the two types of EVDs.DesignSingle centre prospective case-cohort.SubjectsTwenty-five patients with B-EVDs and thirty-four patients with T-EVDs.MethodsClinical notes and radiographic reports were collected before and after the placement of EVDs for patients in ITU between January 2017 and June 2018.ResultsFourteen of the 25 B-EVDs were placed on ITU, of which 2 were under stealth guidance. All 34 T-EVDs were placed in theatre. Mean time to CSF access after decision for diversion was 134 min in the B-EVD group and 227 min in the T-EVD group (p<0.05). Mean survival was 35 days for B-EVDs and 29 days for T-EVDs (p<0.05). Eight T-EVDs went onto be replaced as B-EVDs due to retraction or infection. Complications including infection, detachment or retraction were higher in the T-EVD group at 32% compared to 20% in the B-EVD group.ConclusionsBolt EVDs have a lower frequency of complications and higher survival compared to tunnelled EVDs. Since B-EVDs require fewer resources they can be placed faster and on ITU.

TM3-5 Venous sinus stenting for IIH: what are the long-term outcomes?

2019 ◽  
Vol 90 (3) ◽  
pp. e16.2-e16
Author(s):  
H Asif ◽  
C Craven ◽  
L Thorne ◽  
L Watkins ◽  
A Toma
Keyword(s):  
Stent Placement ◽  
Case Series ◽  
Venous Sinus ◽  
Stent Insertion ◽  
Complication Rates ◽  
Icp Monitoring ◽  
Clinical Notes ◽  
Before And After ◽  
Csf Diversion

ObjectivesIdiopathic intracranial hypertension (IIH) is associated with dural venous sinus stenosis (DVSS). This is increasingly treated with endovascular insertion of stents. Clinical and manometric improvements after stent placement have been described. However, there is little data reporting further need for CSF diversion, complication rates and sustained improvements in ICP.DesignSingle centre case series.SubjectsTwenty-four IIH patients underwent stent insertion on discovery of DVSS with medical management ongoing.MethodsClinical notes, radiographic reports and 24 hour ICP monitoring data before and after stent placement was collected.ResultsAfter 1089.2±107.1 days, 6 patients remained symptomatic and went onto require CSF diversion, 75.0% did not require CSF diversion. One patient developed stent thrombosis requiring VKA anticoagulation for 3 months, this patient also developed new stenosis proximal to the stent at 2 years. A second patient developed in-stent stenosis requiring balloon angioplasty at 2 years and subsequent repeat stenting at 3 years. Eleven patients had 24 hour ICP monitoring at baseline and a mean of 231.9±129.5 days after DVSS stent placement. The mean reduction in ICP was 7.92±1.80 mmHg (p<0.01) and PA was 2.84±0.84 mmHg (p<0.01).ConclusionsDVSS stenting is a viable endovascular therapy for IIH with modest long-term patency and ICP reduction. However, a quarter of stented patients required subsequent CSF diversion to manage their symptoms.

scholarly journals Selective Intensive Care Unit Admission After Adult Supratentorial Tumor Craniotomy: Complications, Length of Stay, and Costs

Neurosurgery ◽  
2019 ◽  
Vol 86 (1) ◽  
pp. E54-E59 ◽  
Author(s):  
Mark ter Laan ◽  
Suzanne Roelofs ◽  
Ineke Van Huet ◽  
Eddy M M Adang ◽  
Ronald H M A Bartels
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Cost Reduction ◽  
Hospital Costs ◽  
Qualitative Evaluation ◽  
Complication Rates ◽  
Supratentorial Tumor ◽  
Before And After ◽  
Supratentorial Tumors

Abstract BACKGROUND Admitting patients to an intensive care or medium care unit (ICU/MCU) after adult supratentorial tumor craniotomy remains common practice even though some studies have suggested lower level care is sufficient for selected patients. We have introduced a “no ICU, unless” policy for tumor craniotomy patients. OBJECTIVE To provide a quieter postoperative environment for patients, reduce the burden on the ICU department, and to evaluate whether costs can be reduced. METHODS A cohort study was performed comparing patients that underwent tumor craniotomy for supratentorial tumors during 1 yr after introduction (n = 109) of the new policy with the year before (n = 107). Rate of complications was evaluated, as was the length of stay and patient satisfaction using qualitative evaluation. Finally, costs were evaluated comparing the situation before and after implementation of the new protocol. RESULTS A reduction in ICU/MCU admittance from 64% to 24% of patients was found resulting in 13.3% cost reduction (€1950 per case), without increasing the length of stay at the ward. The length of stay in the hospital was similar. Complications were significantly reduced after implementing the new policy (0.98 vs 0.53 per patient, P = .003). Patients that were interviewed after the new policy reported feeling safe and at ease at the ward. CONCLUSION Changing our policy from “ICU, unless” to “no ICU, unless” reduced complication rates and length of stay in the hospital while keeping patients satisfied. Hospital costs related to the admission have been significantly reduced by the new policy.

Hydrocephalus-induced neurogenic stunned myocardium and cardiac arrest in a child: completely reversed with CSF diversion

2019 ◽  
Vol 24 (1) ◽  
pp. 35-40
Author(s):  
Gabriel Crevier-Sorbo ◽  
Jeffrey Atkinson ◽  
Tanya Di Genova ◽  
Pramod Puligandla ◽  
Roy W. R. Dudley
Keyword(s):  
Heart Failure ◽  
Cardiac Function ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
External Ventricular Drain ◽  
Outlet Obstruction ◽  
Stunned Myocardium ◽  
Third Ventriculostomy ◽  
Acute Hydrocephalus ◽  
Neurogenic Stunned Myocardium ◽  
Csf Diversion

Neurogenic stunned myocardium (NSM) is a potentially fatal cause of sudden cardiogenic dysfunction due to an acute neurological event, most commonly aneurysmal subarachnoid hemorrhage in adults. Only two pediatric cases of hydrocephalus-induced NSM have been reported. Here the authors report a third case in a 14-year-old boy who presented with severe headache, decreased level of consciousness, and shock in the context of acute hydrocephalus secondary to fourth ventricular outlet obstruction 3 years after standard-risk medulloblastoma treatment. He was initially stabilized with the insertion of an external ventricular drain and vasopressor treatment. He had a profoundly reduced cardiac contractility and became asystolic for 1 minute, requiring cardiopulmonary resuscitation when vasopressors were inadvertently discontinued. Over 1 week, his ventricles decreased in size and his cardiac function returned to normal. All other causes of heart failure were ruled out, and his impressive response to CSF diversion clarified the diagnosis of NSM secondary to hydrocephalus. He was unable to be weaned from his drain during his time in the hospital, so he underwent an endoscopic third ventriculostomy and has remained well with normal cardiac function at more than 6 months’ follow-up. This case highlights the importance of prompt CSF diversion and cardiac support for acute hydrocephalus presenting with heart failure in the pediatric population.

A Before-and-After Study of Evidence-Based Recommendations for On-Call Bronchoscopy

Respiration ◽  
2021 ◽  
pp. 1-11
Author(s):  
Christoph Benedikt Duesberg ◽  
Christina Valtin ◽  
Jan Fuge ◽  
Frank Logemann ◽  
Thomas Fuehner ◽  
...  
Keyword(s):  
Working Hours ◽  
Standard Of Care ◽  
University Hospital ◽  
Relative Reduction ◽  
Evidence Based ◽  
Complication Rates ◽  
Single Centre ◽  
Period 2 ◽  
Before And After ◽  
Before And After Study

<b><i>Background:</i></b> Bronchoscopy is widely used and regarded as standard of care in most intensive care units (ICUs). Data concerning recommendations for on-call bronchoscopy are lacking. <b><i>Objectives:</i></b> Evaluation of recommendations, complications, and outcome of on-call bronchoscopies. <b><i>Method:</i></b> A retrospective single-centre analysis was conducted in a large university hospital. All on-call bronchoscopies performed outside normal working hours in the year before (period 1) and after (period 2) establishing a catalogue of recommendations for indications of on-call bronchoscopy on November 1, 2016, were included. <b><i>Results:</i></b> Overall, 924 bronchoscopies in 538 patients were analysed. A relative reduction of 83.6% from 794 bronchoscopies in 432 patients (1.84 per patient) during period 1 to 130 in 107 patients (1.21 per patient) during period 2 was observed. Most bronchoscopies (812/924, 87.9%) were performed in ICUs, and 416 patients (77.3%) were intubated. Bronchoscopies for excessive secretions decreased significantly during period 2. Fifty-three of 130 bronchoscopies (40.8%) fulfilled the specified recommendations during period 2, in comparison with 16.8% in period 1 (<i>p</i> &#x3c; 0.001). Complications were recorded in 58 of 924 procedures (6.3%) and were more frequent in period 2, especially moderate bleeding. In-hospital mortality of patients undergoing on-call bronchoscopy did not differ between periods and was 28.7 and 30.2% in periods 1 and 2, respectively. <b><i>Conclusion:</i></b> The introduction of recommendations for on-call bronchoscopy led to a significant decline of on-call bronchoscopies without negatively affecting outcome. More evidence is needed in on-call bronchoscopy, especially for ICU patients with intrinsic higher complication rates.

Cataract Surgery in High Hyperopia

2018 ◽  
Vol 235 (04) ◽  
pp. 413-415
Author(s):  
Nicolas Waldmann ◽  
Nadine Gerber ◽  
Warren Hill ◽  
David Goldblum
Keyword(s):  
Cataract Surgery ◽  
Age Related Macular Degeneration ◽  
Complication Rates ◽  
Spherical Equivalent ◽  
Single Centre ◽  
Age Related ◽  
Significant Difference ◽  
Corrected Distance Visual Acuity ◽  
Before And After ◽  
High Hyperopia

Abstract Background Although cataract surgery is a well-established and standardised procedure, it can be demanding and associated with higher complication rates in high hyperopia. We present clinical data for highly hyperopic patients who underwent cataract surgery over a 12-year period (2005 – 2016) and at a single centre. Patients and Methods Out of a total of 11 434 cataract operations, 41 highly hyperopic eyes (SN60AT ≥ 31 dpt) were included for analysis. We compared the target spherical equivalent to the final postoperative spherical equivalent for five different formulas. We also reviewed the best corrected distance visual acuity (BCDVA) before and after surgery and any complications. Results LogMAR BCDVA increased significantly from a mean of 0.5 before to 0.37 after surgery (p = 0.02). The main reasons for the reduced final BCDVA were glaucoma, Fuchs corneal endothelial dystrophy, and age-related macular degeneration. One eye suffered a radial capsule tear and received a sulcus implanted intraocular lens (IOL). There was no statistically significant difference between formulas with respect to aberration of the final spherical equivalent. Conclusions Patients with high hyperopia often have ocular comorbidities. Such eyes may be surgically challenging, resulting in reduced benefits from cataract surgery compared to normal eyes.

scholarly journals Increased blood culture contamination rate during COVID-19 outbreak in intensive care unit: A brief report from a single-centre

2021 ◽  
pp. 175114372110121
Author(s):  
Emanuele Russo ◽  
Giuliano Bolondi ◽  
Emiliano Gamberini ◽  
Domenico Pietro Santonastaso ◽  
Alessandro Circelli ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Contamination Rate ◽  
Single Centre

scholarly journals More skilled clinical management of COVID-19 patients modified mortality in an intermediate respiratory intensive care unit in Italy

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Giovanna E. Carpagnano ◽  
Giovanni Migliore ◽  
Salvatore Grasso ◽  
Vito Procacci ◽  
Emanuela Resta ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Clinical Management ◽  
Average Length ◽  
Limited Attention ◽  
Average Length Of Stay ◽  
Before And After ◽  
Respiratory Intensive Care Unit ◽  
Transferred Patients

Abstract Background Some studies investigated epidemiological and clinical features of laboratory-confirmed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the virus causing coronavirus disease 2019 (COVID-19), but limited attention has been paid to the follow-up of hospitalized patients on the basis of clinical setting and the expertise of clinical management. Methods In the present single-centered, retrospective, observational study, we reported findings from 87 consecutive laboratory-confirmed COVID-19 patients with moderate-to-severe acute respiratory syndrome hospitalized in an intermediate Respiratory Intensive Care Unit (RICU), subdividing the patients in two groups according to the admission date (before and after March 29, 2020). Results With improved skills in the clinical management of COVID-19, we observed a significant lower mortality in the T2 group compared with the T1 group and a significantly difference in terms of mortality among the patients transferred in Intensive Care Unit (ICU) from our intermediate RICU (100% in T1 group vs. 33.3% in T2 group). The average length of stay in intermediate RICU of ICU-transferred patients who survived in T1 and T2 was significantly longer than those who died (who died 3.3 ± 2.8 days vs. who survived 6.4 ± 3.3 days). T Conclusions The present findings suggested that an intermediate level of hospital care may have the potential to modify survival in COVID-19 patients, particularly in the present phase of a more skilled clinical management of the pandemic.

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