Neurocritical care
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Family caregivers of patients with severe acute brain injury (SABI) are at risk for clinically significant chronic emotional distress, including depression, anxiety, and posttraumatic stress. Existing psychosocial interventions for caregivers of intensive care unit (ICU) patients are not tailored to the unique needs of caregivers of patients with SABI, do not demonstrate long-term efficacy, and may increase caregiver burden. In this study, we explored the needs and preferences for psychosocial services among SABI caregivers to inform the development and adaptation of interventions to reduce their emotional distress during and after their relative's ICU admission. ⋯ Our findings provide specific recommendations to justify and inform the development and adaptation of psychosocial support services for SABI caregivers for delivery in the ICU and after discharge.
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Acute ischemic stroke with medium and large vessel occlusion is a leading cause of morbidity and mortality, in which timely intervention with mechanical thrombectomy (MT) is crucial for restoring cerebral blood flow and improving patient outcomes. Effective analgosedation and hemodynamic management during MT are critical to patient outcomes and typically managed by anesthesia. Because of inconsistent anesthesia support at our institution, we implemented a dedicated neurocritical care rapid response team (NCC-RRT) to manage these aspects of care. The primary outcome of our study was door-to-groin puncture time, before and after the implementation of the NCC-RRT. Secondary outcomes included door-to-recanalization time, patient disposition status, and the need for emergent anesthesia support. ⋯ The introduction of a dedicated NCC-RRT led to substantial improvements in MT process efficiency, highlighting the critical role of neurocritical care in optimizing stroke treatment and enhancing patient outcomes. This model offers an effective alternative for centers where dedicated neuroanesthesia teams are unavailable.
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Ultrasonographic optic nerve sheath diameter (ONSD) is a satisfactory noninvasive intracranial pressure (ICP) monitoring test. Our aim was to evaluate ONSD as an objective screening tool to predict and diagnose ICP changes early in sepsis-associated encephalopathy (SAE). ⋯ ONSD could be an objective screening method for early diagnosis of SAE, with a cutoff > 5.2 mm. Trial registration NCT05849831 ( https://clinicaltrials.gov/study/NCT05849831 ).
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Intracranial hemorrhage (ICH) is a devastating stroke subtype with a high rate of mortality and disability. Therapeutic options available are primarily limited to supportive care and blood pressure control, whereas the surgical approach remains controversial. In this study, we explored the effects of noninvasive vagus nerve stimulation (nVNS) on hematoma volume and outcome in a rat model of collagenase-induced ICH. ⋯ nVNS therapy in acute settings may provide a neuroprotective effect and limit hematoma expansion in smaller volumes, improving neurological function post-ICH.
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There have been growing sentiments that the Uniform Determination of Death Act needs to be revised. One suggestion is to include a conscience clause, that is, allowing patients to "opt-out" of brain death determination. Understanding public attitudes toward a conscience clause may help inform policymakers and future proposed revisions. Therefore, we sought to investigate informed public attitudes toward continued medical support after the determination of brain death. ⋯ Nearly half of the participants would require hospitals to continue treatment for families who reject brain death as death. Future discussions on revising the Uniform Determination of Death Act to adopt a conscience clause should consider informed public attitudes.