Methodology for Low-Field, Portable Magnetic Resonance Neuroimaging at the Bedside

Neuroimaging is a critical component of triage and treatment for patients who present with neuropathology. Magnetic resonance imaging and non-contrast computed tomography are the gold standard for diagnosis and prognostication of patients with acute brain injuries. However, these modalities require intra-hospital transport to strict, access-controlled environments, which puts critically ill patients at risk for complications and secondary injuries. A novel, portable MRI (pMRI) device that can be deployed at the patient's bedside provides a needed solution. In a dual-center investigation, Yale New Haven Hospital has obtained regular neuroimaging on patients using the pMRI as part of routine clinical care in the Emergency Department and Intensive Care Unit (ICU) since August of 2020. Massachusetts General Hospital has begun using pMRI in the Neuroscience Intensive Care Unit since January 2021. This technology has expanded the population of patients who can receive MRI imaging by increasing accessibility and timeliness for scan completion by eliminating the need for transport and increasing the potential for serial monitoring. Here we describe our methods for screening, coordinating, and executing pMRI exams and provide further detail on how to scan specific patient populations.

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Identification of Patients at Risk for Development of Tertiary Peritonitis on a Surgical Intensive Care Unit

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-009-0882-y ◽

2009 ◽

Vol 13 (7) ◽

pp. 1358-1367 ◽

Cited By ~ 29

Author(s):

Ansgar M. Chromik ◽

Andreas Meiser ◽

Janine Hölling ◽

Dominique Sülberg ◽

Adrien Daigeler ◽

...

Keyword(s):

Intensive Care Unit ◽

At Risk ◽

Intensive Care ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Tertiary Peritonitis ◽

Patients At Risk

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Qua pote quisque, in ea conterat arte diem: COVID-19 and Australian and New Zealand intensive care

Critical Care and Resuscitation ◽

10.51893/2020.2.ed1 ◽

2020 ◽

Vol 22 (2) ◽

pp. 103-104

Author(s):

Andrew Udy ◽

◽

Keyword(s):

Public Health ◽

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

New Zealand ◽

Severe Acute Respiratory Syndrome ◽

Clinical Care ◽

Public Health Emergency ◽

Care Practice ◽

Health Care Practice

The current global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has thrust intensive care medicine to the forefront of health care practice in Australia and New Zealand. Indeed, reports from other countries and jurisdictions convey highly confronting statistics about the scale of this public health emergency, particularly in terms of the demand on intensive care unit (ICU)services. Whether this occurs here remains to be seen, although if such a scenario does eventuate, it will represent an unprecedented challenge to our community. In parallel, these events offer the opportunity for greater coordination, improved communication, and innovation in clinical care, which are principles that in many ways define our specialty.

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Trauma Intensive Care Unit ‘Bouncebacks': Identifying Risk Factors for Unexpected Return Admission to the Intensive Care Unit

The American Surgeon ◽

10.1177/000313481408000827 ◽

2014 ◽

Vol 80 (8) ◽

pp. 778-782 ◽

Cited By ~ 2

Author(s):

A. Britton Christmas ◽

Elizabeth Freeman ◽

Angela Chisolm ◽

Peter E. Fischer ◽

Gaurav Sachdev ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Brain Injuries ◽

Injury Severity ◽

Hospital Costs ◽

Retrospective Chart Review ◽

Trauma Patients ◽

Respiratory Compromise ◽

Patient Demographics ◽

Hygiene Practices

Return transfer (RT) to the intensive care unit (ICU) negatively impacts patient outcomes, length of stay (LOS), and hospital costs. This study assesses the most common events necessitating RT in trauma patients. We performed a retrospective chart review of ICU RT from 2004 to 2008. Patient demographics, injuries and injury severity, reason for transfer, LOS, interventions, and outcomes data were collected. Overall, 158 patients required readmission to the ICU. Respiratory insufficiency/ failure (48%) was the most common reason for RT followed by cardiac (16%) and neurological (13%) events. The most commonly associated injuries were traumatic brain injuries (TBIs) (32%), rib fractures (30%), and pulmonary contusions (20%). Initial ICU LOS was 6.6 ± 8 days (range, 1 to 44 days) with 4.4 ± 7.8 ventilator days. Mean floor time before ICU RT was 5.7 ± 6.3 days (range, 0 to 33 days). Forty-nine patients (31%) required intubation and mechanical ventilation on RT. ICU RT incurred an additional ICU LOS of 8 ± 8.5 days (range, 1 to 40 days) and 5.2 ± 7.5 ventilator days. Mortality after a single RT was 10 per cent (n = 16). RT to the ICU most often occurs as a result of respiratory compromise, and patients with TBI are particularly vulnerable. Trauma pulmonary hygiene practices should be evaluated to determine strategies that could decrease RT.

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Role of the intensive care unit

10.1093/med/9780199568741.003.0148 ◽

2018 ◽

Author(s):

Matt Wise ◽

Paul Frost

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Organ Failure ◽

Radiology Department ◽

Organ Support ◽

Specific Patient ◽

High Dependency ◽

Operating Theatres ◽

The Uk ◽

General Wards

The intensive care unit (ICU) can be defined as an area reserved for patients with potential or established organ failure and has the facilities for the diagnosis, prevention, and treatment of multi-organ failure. Usually, the ICU is located in close proximity to A & E, the radiology department, and the operating theatres, as it is between these areas that patient flows are greatest. In large urban hospitals, there may be more than one ICU, some of which serve specific patient populations, such as paediatrics, neurosurgery, cardiothoracic surgery, liver failure, and burns. Many hospitals also have high-dependency units (HDUs) that offer higher nurse-to-patient ratios and more advanced monitoring than a general wards does, as well as limited organ support. In the UK, the distinctions between ICU, HDU, and general ward have been abandoned in favour of a classification based on the patient’s needs rather than their location.

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Clinical Decision Making in the ICU: Dysphagia Screening, Assessment, and Treatment

Seminars in Speech and Language ◽

10.1055/s-0039-1688980 ◽

2019 ◽

Vol 40 (03) ◽

pp. 170-187 ◽

Cited By ~ 4

Author(s):

Martin B. Brodsky ◽

Emily B. Mayfield ◽

Roxann Diez Gross

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Intensive Care ◽

Clinical Decision Making ◽

Clinical Care ◽

Clinical Decision ◽

Level Of Care ◽

Assessment And Treatment ◽

Proper Training ◽

Screening Assessment

AbstractClinicians often perceive the intensive care unit as among the most intimidating environments in patient care. With the proper training, acquisition of skill, and approach to clinical care, feelings of intimidation may be overcome with the great rewards this level of care has to offer. This review—spanning the ages of birth to senescence and covering oral/nasal endotracheal intubation and tracheostomy—presents a clinically relevant, directly applicable review of screening, assessment, and treatment of dysphagia in the patients who are critically ill for clinical speech–language pathologists and identifies gaps in the clinical peer-reviewed literature for researchers.

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Deep sedation with propofol for children undergoing ambulatory magnetic resonance imaging of the brain: Experience from a pediatric intensive care unit

Pediatric Critical Care Medicine ◽

10.1097/01.pcc.0000090013.66899.33 ◽

2003 ◽

Vol 4 (4) ◽

pp. 454-458 ◽

Cited By ~ 46

Author(s):

Rashed A. Hasan ◽

Jay R. Shayevitz ◽

Vipul Patel

Keyword(s):

Magnetic Resonance Imaging ◽

Intensive Care Unit ◽

Intensive Care ◽

Magnetic Resonance ◽

Pediatric Intensive Care Unit ◽

Deep Sedation ◽

Pediatric Intensive Care ◽

Resonance Imaging ◽

The Brain

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Discharge prescribing of enteral opioids after initiation as a weaning strategy from continuous opioid infusions in the Intensive Care Unit

Journal of Opioid Management ◽

10.5055/jom.2018.0427 ◽

2018 ◽

Vol 14 (1) ◽

pp. 35 ◽

Cited By ~ 5

Author(s):

Bridgette Kram, PharmD, BCPS, BCCCP ◽

Kylie M. Weigel, PharmD, BCPS ◽

Michelle Kuhrt, PharmD ◽

Daniel L. Gilstrap, MD

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Discharge ◽

Physical Dependence ◽

Total Duration ◽

Opioid Therapy ◽

Hospital Length ◽

Patients At Risk ◽

Long Acting ◽

Discharge Prescription

Objective: To evaluate the proportion of patients receiving a hospital discharge prescription for a scheduled enteral opioid following initiation as a weaning strategy from a continuous opioid infusion in the Intensive Care Unit (ICU).Design: Retrospective, observational study.Setting: Five adult ICUs at a large, quaternary care academic medical center.Patients: Endotracheally intubated, opioid-naive adults receiving a continuous opioid infusion with a concomitant scheduled enteral opioid initiated. Exclusion criteria were receipt of fewer than two enteral opioid doses, documentation of a long-acting opioid as a home medication, the indication for the enteral opioid was not a weaning strategy, death during hospital admission or discharge to hospice. Interventions: None.Main outcome measures: The proportion of ICU and hospital survivors who received a discharge prescription for a scheduled enteral opioid, total duration of continuous opioid infusion, duration of continuous opioid infusion after initiation of an enteral opioid therapy, total duration of enteral therapy, ICU and hospital length of stay.Results: Of 62 included patients, 19 patients (30.6 percent) received a new prescription for a scheduled enteral opioid at hospital discharge. The median duration of enteral opioid therapy was longer for patients who received a discharge prescription compared to those who did not (20.09 vs 8.89 days, p = 0.02), though the remaining endpoints were not different.Conclusions: Utilizing scheduled enteral opioids as a weaning strategy from continuous opioid infusions may place patients at risk of ICU-acquired physical dependence on opioids.

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Use of a Comprehensive Program to Reduce the Incidence of Hospital-Acquired Pressure Ulcers in an Intensive Care Unit

American Journal of Critical Care ◽

10.4037/ajcc2016963 ◽

2016 ◽

Vol 25 (2) ◽

pp. 152-155 ◽

Cited By ~ 20

Author(s):

Katie Swafford ◽

Rachel Culpepper ◽

Christina Dunn

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Prevention Program ◽

Pressure Ulcers ◽

Potential Cost ◽

Adult Intensive Care Unit ◽

Care Protocol ◽

Patients At Risk ◽

Program Components ◽

Hospital Acquired

Background Hospital-acquired pressure ulcers (HAPUs) are a costly and largely preventable complication occurring in a variety of acute care settings. Because they are considered preventable, stage III and IV HAPUs are not reimbursed by Medicare. Objectives To assess the effectiveness of a formal, year-long HAPU prevention program in an adult intensive care unit, with a goal of achieving at least a 50% reduction in 2013, compared with 2011. Methods Planning for the prevention program began in 2012, and the program was rolled out in the first quarter of 2013. Program components included use of Braden scores, a revised skin care protocol, fluidized repositioners, and silicone gel adhesive dressings. Efforts were made to educate and motivate staff and encourage them to be more proactive in detecting patients at risk of HAPUs. Results Incidence of HAPUs in the unit was reduced by 69% (n = 17; 3% of patients in 2013 vs n = 45, 10% of patients in 2011), despite a 22% increase in patient load. The potential cost saving as a result of this decrease was approximately $1 million. Conclusions A comprehensive, proactive, collaborative ulcer prevention program based on staff education and a focus on adherence to protocols for patient care can be an effective way to reduce the incidence of HAPUs in intensive care units.

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