scholarly journals Management of Patients with Brain Injury Using Noninvasive Methods

2020 ◽  
Author(s):  
Gustavo Frigieri ◽  
Nicollas Nunes Rabelo ◽  
Ricardo de Carvalho Nogueira ◽  
Sérgio Brasil
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Brain Injury ◽  
Intensive Care Units ◽  
Clinical Parameters ◽  
Noninvasive Methods ◽  
Brain Injured ◽  
Medical Teams ◽  
Injured Patients

In the last decades, the development of new noninvasive technologies in critical care allowed physicians to continuously monitor clinical parameters, aggregating important information that has been previously inaccessible or restricted due to the invasiveness of the existing techniques. The aim of this chapter is to present noninvasive methods in use on intensive care units (ICU) for brain injured patients monitoring, collaborating to the diagnosis and follow-up, aiding medical teams to achieve better outcomes.

scholarly journals A gap existed between physicians’ perceptions and performance of pain, agitation-sedation and delirium assessments in Chinese intensive care units

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kai Chen ◽  
Yan-Lin Yang ◽  
Hong-Liang Li ◽  
Dan Xiao ◽  
Yang Wang ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Clinical Performance ◽  
Sedation Scale ◽  
Delirium Assessment ◽  
Brain Injured ◽  
Delirium Management ◽  
And Performance ◽  
Injured Patients

Abstract Background Pain, agitation-sedation and delirium management are crucial elements in the care of critically ill patients. In the present study, we aimed to present the current practice of pain, agitation-sedation and delirium assessments in Chinese intensive care units (ICUs) and investigate the gap between physicians’ perception and actual clinical performance. Methods We sent invitations to the 33 members of the Neuro-Critical Care Committee affiliated with the Chinese Association of Critical Care Physicians. Finally, 24 ICUs (14 general-, 5 neuroscience-, 3 surgical-, and 2 emergency-ICUs) from 20 hospitals participated in this one-day point prevalence study combined with an on-site questionnaire survey. We enrolled adult ICU admitted patients with a length of stay ≥24 h, who were divided into the brain-injured group or non-brain-injured group. The hospital records and nursing records during the 24-h period prior to enrollment were reviewed. Actual evaluations of pain, agitation-sedation and delirium were documented. We invited physicians on-duty during the 24 h prior to the patients’ enrollment to complete a survey questionnaire, which contained attitude for importance of pain, agitation-sedation and delirium assessments. Results We enrolled 387 patients including 261 (67.4%) brain-injured and 126 (32.6%) non-brain-injured patients. There were 19.9% (95% confidence interval [CI]: 15.9–23.9%) and 25.6% (95% CI: 21.2–29.9%) patients receiving the pain and agitation-sedation scale assessment, respectively. The rates of these two types of assessments were significantly lower in brain-injured patients than non-brain-injured patients (p = 0.003 and < 0.001). Delirium assessment was only performed in three patients (0.8, 95% CI: 0.1–1.7%). In questionnaires collected from 91 physicians, 70.3% (95% CI: 60.8–79.9%) and 82.4% (95% CI: 74.4–90.4%) reported routine use of pain and agitation-sedation scale assessments, respectively. More than half of the physicians (52.7, 95% CI: 42.3–63.2%) reported daily screening for delirium using an assessment scale. Conclusions The actual prevalence of pain, agitation-sedation and delirium assessment, especially delirium screening, was suboptimal in Chinese ICUs. There is a gap between physicians’ perceptions and actual clinical practice in pain, agitation-sedation and delirium assessments. Our results will prompt further quality improvement projects to optimize the practice of pain, agitation-sedation and delirium management in China. Trial registration ClinicalTrials.gov, identifier NCT03975751. Retrospectively registered on 2 June 2019.

Multimodality Monitoring

2018 ◽  
pp. 155-164
Author(s):  
Maranatha Ayodele ◽  
Kristine O’Phelan
Keyword(s):  
Traumatic Brain Injury ◽  
Critical Care ◽  
Brain Injury ◽  
Early Recognition ◽  
Secondary Injury ◽  
Multimodality Monitoring ◽  
Injured Brain ◽  
Brain Injured ◽  
Physiologic Parameters ◽  
Injured Patients

Advancements in the critical care of patients with various forms of acute brain injury (traumatic brain injury, subarachnoid hemorrhage, stroke, etc.) in its current evolution recognizes that in addition to the initial insult, there is a secondary cascade of physiological events in the injured brain that contribute significantly to morbidity and mortality. Multimodality monitoring (MMM) in neurocritical care aims to recognize this secondary cascade in a timely manner. With early recognition, critical care of brain-injured patients may then be tailored to preventing and alleviating this secondary injury. MMM includes a variety of invasive and noninvasive techniques aimed at monitoring brain physiologic parameters such as intracranial pressure, perfusion, oxygenation, blood flow, metabolism, and electrical activity. This chapter provides an overview of these techniques and offers a practical guide to their integration and use in the intensive care setting.

scholarly journals Residual Pituitary Function after Brain Injury-Induced Hypopituitarism: A Prospective 12-Month Study

2005 ◽  
Vol 90 (11) ◽  
pp. 6085-6092 ◽  
Author(s):  
Gianluca Aimaretti ◽  
Maria Rosaria Ambrosio ◽  
Carolina Di Somma ◽  
Maurizio Gasperi ◽  
Salvatore Cannavò ◽  
...  
Keyword(s):  
Brain Injury ◽  
High Risk ◽  
Gh Deficiency ◽  
Pituitary Function ◽  
Brain Injured ◽  
Injured Patients ◽  
The Brain ◽  
Over Time

Abstract Context: Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are conditions at high risk for the development of hypopituitarism. Objective: The objective of the study was to clarify whether pituitary deficiencies and normal pituitary function recorded at 3 months would improve or worsen at 12 months after the brain injury. Design and Patients: Pituitary function was tested at 3 and 12 months in patients who had TBI (n = 70) or SAH (n = 32). Results: In TBI, the 3-month evaluation had shown hypopituitarism (H) in 32.8%. Panhypopituitarism (PH), multiple (MH), and isolated (IH) hypopituitarism had been demonstrated in 5.7, 5.7, and 21.4%, respectively. The retesting demonstrated some degree of H in 22.7%. PH, MH, and IH were present in 5.7, 4.2, and 12.8%, respectively. PH was always confirmed at 12 months, whereas MH and IH were confirmed in 25% only. In 5.5% of TBI with no deficit at 3 months, IH was recorded at retesting. In 13.3% of TBI with IH at 3 months, MH was demonstrated at 12-month retesting. In SAH, the 3-month evaluation had shown H in 46.8%. MH and IH had been demonstrated in 6.2 and 40.6%, respectively. The retesting demonstrated H in 37.5%. MH and IH were present in 6.2 and 31.3%, respectively. Although no MH was confirmed at 12 months, two patients with IH at 3 months showed MH at retesting; 30.7% of SAH with IH at 3 months displayed normal pituitary function at retesting. In SAH, normal pituitary function was always confirmed. In TBI and SAH, the most common deficit was always severe GH deficiency. Conclusion: There is high risk for H in TBI and SAH patients. Early diagnosis of PH is always confirmed in the long term. Pituitary function in brain-injured patients may improve over time but, although rarely, may also worsen. Thus, brain-injured patients must undergo neuroendocrine follow-up over time.

scholarly journals A comparison of standard occupational therapy versus early enhanced occupation-based therapy in a medical / surgical intensive care unit: study protocol for a single site feasibility trial (EFFORT-ICU).

2020 ◽  
Author(s):  
Andrea Rapolthy-Beck ◽  
Jennifer Fleming ◽  
Merrill Turpin ◽  
Kellie Sosnowski ◽  
Simone Dullaway ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Occupational Therapy ◽  
Intensive Care Units ◽  
Intervention Group ◽  
Single Site ◽  
Phase Iii ◽  
Feasibility Trial ◽  
Surgical Intensive Care Unit

Abstract Background: Admissions to intensive care units (ICUs) are increasing due to an aging population, and rising incidence of cardiac and respiratory disease. With advances in medical care, more patients are surviving an initial stay in critical care; however, they can experience ongoing health and cognitive limitations, that may influence return to baseline function up to a year post-admission. Recent research has focused on the introduction of early rehabilitation within the ICU to reduce long-term physical and cognitive complications. The aim of this study is to explore the feasibility and impact of providing early occupational therapy intervention, including cognitive stimulation and activities of daily living, to patients in intensive care.Methods: This study involves a single site randomised-controlled feasibility trial comparing standard occupational therapy care to an enhanced occupation-based therapy. Thirty mechanically ventilated ICU patients will be recruited and randomly allocated to the intervention or control group. The primary outcome measure is the Functional Independence Measure (FIM), and secondary measures include the Modified Barthel Index (MBI), Montreal Cognitive Assessment (MoCA), grip strength, Hospital Anxiety and Depression Scale (HADS) and Short-Form 36 Health survey (SF-36). Measures will be collected by a blind assessor at discharge from intensive care, hospital discharge and a 90-day follow-up. Daily outcome measures including the Glasgow Coma Scale (GCS), Richmond Agitation and Sedation Scale (RASS) and Confusion Assessment Measure for intensive care units (CAM-ICU) will be taken prior to treatment. Participants in the intervention group will receive daily 60 minute sessions with an occupational therapist involving cognitive and functional activities such as self-care and grooming. At the follow-up, intervention group participants will be interviewed to gain user perspectives of the intervention. Feasibility data including recruitment and retention rates will be summarised descriptively. Parametric tests will compare outcomes between groups. Interview data will be thematically analysed.Discussion: This trial will provide information about the feasibility of investigating how occupational therapy interventions in ICU influence longer term outcomes. It aims to inform the design of a phase III multicentre trial of occupational therapy in critical care general medical intensive care units.Trial registration: Australia New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618000374268; prospectively registered on 13th March 2018 / https://www.anzctr.org.au

scholarly journals Multicentre observational study on practice of ventilation in brain injured patients: the VENTIBRAIN study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047100
Author(s):  
Chiara Robba ◽  
Giuseppe Citerio ◽  
Fabio S Taccone ◽  
Stefania Galimberti ◽  
Paola Rebora ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Brain Injury ◽  
Observational Study ◽  
Annual Conference ◽  
Lung Protection ◽  
Arterial Blood ◽  
Brain Injured ◽  
Injured Patients ◽  
Ventilator Settings

IntroductionMechanical ventilatory is a crucial element of acute brain injured patients’ management. The ventilatory goals to ensure lung protection during acute respiratory failure may not be adequate in case of concomitant brain injury. Therefore, there are limited data from which physicians can draw conclusions regarding optimal ventilator management in this setting.Methods and analysisThis is an international multicentre prospective observational cohort study. The aim of the ‘multicentre observational study on practice of ventilation in brain injured patients’—the VENTIBRAIN study—is to describe the current practice of ventilator settings and mechanical ventilation in acute brain injured patients. Secondary objectives include the description of ventilator settings among different countries, and their association with outcomes. Inclusion criteria will be adult patients admitted to the intensive care unit (ICU) with a diagnosis of traumatic brain injury or cerebrovascular diseases (intracranial haemorrhage, subarachnoid haemorrhage, ischaemic stroke), requiring intubation and mechanical ventilation and admission to the ICU. Exclusion criteria will be the following: patients aged <18 years; pregnant patients; patients not intubated or not mechanically ventilated or receiving only non-invasive ventilation. Data related to clinical examination, neuromonitoring if available, ventilator settings and arterial blood gases will be recorded at admission and daily for the first 7 days and then at day 10 and 14. The Glasgow Outcome Scale Extended on mortality and neurological outcome will be collected at discharge from ICU, hospital and at 6 months follow-up.Ethics and disseminationThe study has been approved by the Ethic committee of Brianza at the Azienda Socio Sanitaria Territoriale-Monza. Data will be disseminated to the scientific community by abstracts submitted to the European Society of Intensive Care Medicine annual conference and by original articles submitted to peer-reviewed journals.Trial registration numberNCT04459884.

scholarly journals Non-intensivist training to increase the staff capacity of intensive care units during COVID-19 pandemic surge in Argentina

2021 ◽  
pp. 1-20
Author(s):  
Ezequiel Monteverde ◽  
Laura Bosque ◽  
Roberto Klappenbach ◽  
Joaquín Baliña ◽  
Betina Lartigue ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Public Hospitals ◽  
Success Rates ◽  
Private Companies ◽  
Web Based ◽  
Academic Organizations ◽  
Assignment Strategy

Abstract Objective: To report the results of a nationwide critical-care course for non-intensivists to increase staff capacity of intensive care units (ICU) during the COVID-19 pandemic in Argentina. Methods: Three academic organizations, with special funding from 55 private companies, developed a short virtual course comprised of web-based videos, virtual tutorials, and a forum chat. Each state assigned scholarships to non-ICU staff from public hospitals. Students received active follow-up for the completion of the course and took a survey upon course completion. Results: After four months, there were 10,123 students registered from 661 hospitals in 328 cities. Of these, 67.8% passed the course, 29.1% were still ongoing and 3.1% were inactive. Most students were female (74.2%) with a median of 37 years old (IQR 31-44). The group was composed of 56.5% nurses, 36.2% physicians, and 7.4% physiotherapists, of whom 48.3% did not have any experience in critical care. Mean overall satisfaction was 4.4/5 (SD 0.9), and 90.7% considered they were able to apply the contents to their practice. Conclusions: This course was effective for rapid training of non-ICU personnel. The assignment strategy, the educational techniques, and the close follow-up led to low dropout and high success rates and satisfaction.

scholarly journals A comparison of standard occupational therapy versus early enhanced occupation-based therapy in a medical/surgical intensive care unit: study protocol for a single site feasibility trial (EFFORT-ICU)

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Andrea Rapolthy-Beck ◽  
Jennifer Fleming ◽  
Merrill Turpin ◽  
Kellie Sosnowski ◽  
Simone Dullaway ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Occupational Therapy ◽  
Intensive Care Units ◽  
Intervention Group ◽  
Single Site ◽  
Trial Registration ◽  
Feasibility Trial ◽  
Link Type

Abstract Background Admissions to intensive care units (ICUs) are increasing due to an ageing population, and rising incidence of cardiac and respiratory disease. With advances in medical care, more patients are surviving an initial stay in critical care; however, they can experience ongoing health and cognitive limitations that may influence return to baseline function up to a year post-admission. Recent research has focused on the introduction of early rehabilitation within the ICU to reduce long-term physical and cognitive complications. The aim of this study is to explore the feasibility and impact of providing early enhanced occupation-based therapy, including cognitive stimulation and activities of daily living, to patients in intensive care. Methods This study involves a single site randomised-controlled feasibility trial comparing standard occupational therapy care to an early enhanced occupation-based therapy. Thirty mechanically ventilated ICU patients will be recruited and randomly allocated to the intervention or control group. The primary outcome measure is the Functional Independence Measure (FIM), and secondary measures include the Modified Barthel Index (MBI), Montreal Cognitive Assessment (MoCA), grip strength, Hospital Anxiety and Depression Scale (HADS) and Short-Form 36 Health survey (SF-36). Measures will be collected by a blind assessor at discharge from intensive care, hospital discharge and a 90-day follow-up. Daily outcome measures including the Glasgow Coma Scale (GCS), Richmond Agitation and Sedation Scale (RASS) and Confusion Assessment Measure for intensive care units (CAM-ICU) will be taken prior to treatment. Participants in the intervention group will receive daily a maximum of up to 60-min sessions with an occupational therapist involving cognitive and functional activities such as self-care and grooming. At the follow-up, intervention group participants will be interviewed to gain user perspectives of the intervention. Feasibility data including recruitment and retention rates will be summarised descriptively. Parametric tests will compare outcomes between groups. Interview data will be thematically analysed. Discussion This trial will provide information about the feasibility of investigating how occupational therapy interventions in ICU influence longer term outcomes. It seeks to inform the design of a phase III multicentre trial of occupational therapy in critical care general medical intensive care units. Trial registration Australia New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618000374268; prospectively registered on 13 March 2018/https://www.anzctr.org.au Trial funding: Metro South Health Research Support Scheme Postgraduate Scholarship

scholarly journals A comparison of standard occupational therapy versus early enhanced occupation-based therapy in a medical / surgical intensive care unit: study protocol for a single site feasibility trial (EFFORT-ICU).

2021 ◽  
Author(s):  
Andrea Rapolthy-Beck ◽  
Jennifer Fleming ◽  
Merrill Turpin ◽  
Kellie Sosnowski ◽  
Simone Dullaway ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Occupational Therapy ◽  
Intensive Care Units ◽  
Intervention Group ◽  
Single Site ◽  
Phase Iii ◽  
Feasibility Trial ◽  
Surgical Intensive Care Unit

Abstract Background: Admissions to intensive care units (ICUs) are increasing due to an aging population, and rising incidence of cardiac and respiratory disease. With advances in medical care, more patients are surviving an initial stay in critical care; however, they can experience ongoing health and cognitive limitations, that may influence return to baseline function up to a year post-admission. Recent research has focused on the introduction of early rehabilitation within the ICU to reduce long-term physical and cognitive complications. The aim of this study is to explore the feasibility and impact of providing early enhanced occupation-based therapy, including cognitive stimulation and activities of daily living, to patients in intensive care. Methods: This study involves a single site randomised-controlled feasibility trial comparing standard occupational therapy care to an early enhanced occupation-based therapy. Thirty mechanically ventilated ICU patients will be recruited and randomly allocated to the intervention or control group. The primary outcome measure is the Functional Independence Measure (FIM), and secondary measures include the Modified Barthel Index (MBI), Montreal Cognitive Assessment (MoCA), grip strength, Hospital Anxiety and Depression Scale (HADS) and Short-Form 36 Health survey (SF-36). Measures will be collected by a blind assessor at discharge from intensive care, hospital discharge and a 90-day follow-up. Daily outcome measures including the Glasgow Coma Scale (GCS), Richmond Agitation and Sedation Scale (RASS) and Confusion Assessment Measure for intensive care units (CAM-ICU) will be taken prior to treatment. Participants in the intervention group will receive daily a maximum of up to 60 minute sessions with an occupational therapist involving cognitive and functional activities such as self-care and grooming. At the follow-up, intervention group participants will be interviewed to gain user perspectives of the intervention. Feasibility data including recruitment and retention rates will be summarised descriptively. Parametric tests will compare outcomes between groups. Interview data will be thematically analysed.Discussion: This trial will provide information about the feasibility of investigating how occupational therapy interventions in ICU influence longer term outcomes. It seeks to inform the design of a phase III multicentre trial of occupational therapy in critical care general medical intensive care units.Trial registration: Australia New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618000374268; prospectively registered on 13th March 2018 / https://www.anzctr.org.auTrial funding: Metro South Health Research Support Scheme Postgraduate Scholarship

scholarly journals Paediatric admissions to a district general hospital adult intensive care unit over a six year period: A single centre retrospective case series, with review of practitioner confidence and competence in paediatric critical care

2021 ◽  
pp. 175114372110121
Author(s):  
Stephen A Spencer ◽  
Joanna S Gumley ◽  
Marcin Pachucki
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Case Series ◽  
Critically Ill Children ◽  
Single Centre ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Paediatric Critical Care ◽  
Doctors And Nurses

Background Critically ill children presenting to district general hospitals (DGH) are admitted to adult intensive care units (AICUs) for stabilisation prior to transfer to paediatric intensive care units (PICUs). Current training in PICU for adult intensive care physicians is only three months. This single centre retrospective case series examines the case mix of children presenting to a DGH AICU and a multidisciplinary survey assesses confidence and previous experience, highlighting continued training needs for DGH AICU staff. Methods all paediatric admissions to AICU and paediatric retrievals were reviewed over a 6-year period (2014-2019). Cases were identified from the Electronic Patient Record (EPR) and from data provided by the regional paediatric retrieval service. A questionnaire survey was sent to AICU doctors and nurses to assess confidence and competence in paediatric critical care. Results Between 2014-2019, 284 children were managed by AICU. In total 35% of cases were <1 y, 48% of cases were <2 y and 64% of cases were <5 y, and 166/284 (58%) children were retrieved. Retrieval reduced with increasing age (OR 0.49 [0.40-0.60], p < 0.0001). The survey had an 82% response rate, and highlighted that only 13% of AICU nurses and 50% of doctors had received prior PICU training. Conclusion At least one critically unwell child presents to the AICU each week. Assessment, stabilisation and management of critically unwell children are vital skills for DGH AICU staff, but confidence and competence are lacking. Formalised strategies are required to develop and maintain paediatric competencies for AICU doctors and nurses.

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