Serum biomarkers for risk assessment of intra-hospital transports in neurosurgical intensive care unit patients

Author(s):  
Michael BENDER ◽  
Jessica UTERMARCK ◽  
Eberhard UHL ◽  
Marco STEIN
2019 ◽  
pp. 088506661989106
Author(s):  
Michael Bender ◽  
Marco Stein ◽  
Seong Woong Kim ◽  
Eberhard Uhl ◽  
Karsten Schöller

Objective: Intrahospital transports (IHTs) of neurosurgical intensive care unit (NICU) patients can be hazardous. Increasing intracranial pressure (ICP) and/or decreasing cerebral perfusion pressure (CPP) as well as cardiopulmonary alterations are common complications of an IHTs, which can lead to secondary brain injury. This study was performed to assess several serum biomarkers concerning their potential to improve safety of IHTs in mechanically ventilated NICU patients. Methods: All IHTs of mechanically ventilated and sedated NICU patients from 03/2017 to 01/2018 were retrospectively analyzed. Intracranial pressure and CPP measurements were performed in all patients. Serum hemoglobin, hematocrit, and serum sodium were defined as serum biomarkers. Demographic data, computed tomography scan on admission, Simplified Acute Physiology Score and Acute Physiology and Chronic Health Evaluation II, modified Rankin Scale, indication and consequence of IHTs were analyzed. Alteration of ICP/CPP, hemodynamic and pulmonary events were defined as complications. The study population was stratified into patients with the occurrence of a complication and absence of a complication. Results: We analyzed a total number of 184 IHTs in 70 NICU patients with an overall complication rate of 57.6%. Of all, 32.1% IHTs had no direct therapeutic consequence. In patients with higher hemoglobin values prior to IHT less complications occurred, concerning ICP ( P = .001), CPP ( P = .001), hemodynamic ( P = .005), and pulmonary ( P < .0001) events. In addition, complications concerning ICP ( P = .001), CPP ( P = .001), hemodynamic ( P = .005), and pulmonary problems ( P = .002) were significantly lower in patients with higher hematocrit values before IHT. Conclusion: Intrahospital transports of mechanically ventilated NICU patients carry a high risk of increased ICP and hemodynamic complications and should be performed restrictively. Higher values of hemoglobin and hematocrit prior to IHT were associated with less complications with regard to ICP, CPP as well as hemodynamic and pulmonary events and could be helpful to assess the potential risk of complications prior to IHTs.


2007 ◽  
Vol 65 (2) ◽  
pp. 181-182 ◽  
Author(s):  
A. Lasheras ◽  
A.M. Rogues ◽  
S. Peyrere ◽  
G. Boulard ◽  
C.M. Bebear ◽  
...  

Author(s):  
Choo Hwee Poi ◽  
Mervyn Yong Hwang Koh ◽  
Tessa Li-Yen Koh ◽  
Yu-Lin Wong ◽  
Wendy Yu Mei Ong ◽  
...  

Objectives: We conducted a pilot quality improvement (QI) project with the aim of improving accessibility of palliative care to critically ill neurosurgical patients. Methods: The QI project was conducted in the neurosurgical intensive care unit (NS-ICU). Prior to the QI project, referral rates to palliative care were low. The ICU-Palliative Care collaborative comprising of the palliative and intensive care team led the QI project from 2013 to 2015. The interventions included engaging key stake-holders, establishing formal screening and referral criteria, standardizing workflows and having combined meetings with interdisciplinary teams in ICU to discuss patients’ care plans. The Palliative care team would review patients for symptom optimization, attend joint family conferences with the ICU team and support patients and families post-ICU care. We also collected data in the post-QI period from 2016 to 2018 to review the sustainability of the interventions. Results: Interventions from our QI project and the ICU-Palliative Care collaborative resulted in a significant increase in the number of referrals from 9 in 2012 to 44 in 2014 and 47 the year later. The collaboration was beneficial in facilitating transfers out of ICU with more deaths outside ICU on comfort-directed care (96%) than patients not referred (75.7%, p < 0.05). Significantly more patients had a Do-Not-Resuscitation (DNR) order upon transfer out of ICU (89.7%) compared to patients not referred (74.2.%, p < 0.001), and had fewer investigations in the last 48 hours of life (p < 0.001). Per-day ICU cost was decreased for referred patients (p < 0.05). Conclusions: Multi-faceted QI interventions increased referral rates to palliative care. Referred patients had fewer investigations at the end-of-life and per-day ICU costs.


2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Gulsah Kose ◽  
Keziban Şirin ◽  
Mehtap Balin Inel ◽  
Sevcan Mertoglu ◽  
Raziye Aksakal ◽  
...  

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