Neurocritical care
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Neuropalliative care is an emerging subspecialty of palliative care designed to address the unique supportive care needs of patients with serious neurological illness, including those receiving neurocritical care in intensive care units. Spiritual care is a vital component in the provision of holistic and humanized care to these patients. A chaplain who is specially trained and credentialed in care for those with serious illness is the health care professional responsible for making spiritual assessments and contributes to the plan of care, facilitating decision making, and guiding other clinicians in the provision of generalist spiritual care. ⋯ These cases clarify the role of professionally trained and credentialed chaplains with experience in both neurocritical and palliative care and the value added to the interprofessional team.
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Acute ischemic lesions seen on brain magnetic resonance imaging (MRI) are associated with poor intracerebral hemorrhage (ICH) outcomes, but drivers for these lesions are unknown. Rapid hemoglobin decrements occur in the initial days after ICH and may impair brain oxygen delivery. We investigated whether acute hemoglobin decrements after ICH are associated with MRI ischemic lesions and poor long-term ICH outcomes. ⋯ Greater hemoglobin decrements after acute ICH are associated with ischemic lesions on brain MRI and poor long-term outcomes. Further work is required to clarify drivers for these relationships and whether anemia treatment and prevention can be used to improve ICH outcomes.
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This study aims to evaluate the safety of visual percutaneous tracheostomy (vPDT) in neurologic intensive care unit (NICU) patients who are under anticoagulant and antithrombotic therapy. ⋯ vPDT appears to be a safe and feasible procedure for NICU patients receiving anticoagulant and antithrombotic therapy, with no significant increase in complications compared to those not on such therapies.
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Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in the older adult population, and palliative care consultation can assist in goals-of-care discussions. However, patterns of hospital care delivered before consultation are understudied for older adult patients with TBI. The objective of this study was to identify demographic and clinical drivers of preconsultation care intensity in this population. ⋯ Demographic factors such as sex and race were associated with differential prepalliative care consultation care intensity. Although MLS was associated with increased care intensity in the original multivariable model, when considering complex interactions between variables, greater injury severity drove decreased care intensity potentially due to perceptions of medical futility. These findings serve to inform discussions about disparities and clinical considerations surrounding palliative care for older adult patients with TBI.