Neurocritical care
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Review Case Reports
Orthostatic hypotension following resection of a dorsal medullary hemangioblastoma.
Orthostatic hypotension (OH) is an uncommon, but not rare manifestation of dorsal medullary lesions which has less commonly been described as arising de novo or significantly worsening following surgical resection of the lesion. ⋯ OH is an uncommon manifestation of dorsal medullary lesions and can rarely show significant worsening in severity following surgical resection of the lesion. Medical management in conjunction with physical rehabilitation may potentially result in recovery.
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Cerebral venous sinus thrombosis (CVST) often occurs in young patients and is treated with acute and then long-term oral anticoagulation. It is important to decide when to discontinue anticoagulation, as lifelong anticoagulation exposes the patient to considerable cumulative risk. ⋯ In addition, when no direct evidence is available, we discuss and extrapolate from the more comprehensively studied situation of systemic venous thromboembolic disease. Recommendations are graded using standard criteria for the level of evidence.
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Clinical trials provide a robust mechanism to advance science and change clinical practice across the widest possible spectrum. Fundamental in the Neurocritical Care Society's mission is to promote Quality Patient Care by identifying and implementing best medical practices for acute neurological disorders that are consistent with the current scientific knowledge. The next logical step will be to foster rapid growth of our scientific body of evidence, to establish and disseminate these best practices. In this manuscript, five invited experts were impaneled to address questions, identified by the conference organizing committee as fundamental issues for the design of clinical trials in the neurological intensive care unit setting.
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Neurocritical care is a subspecialty of critical care medicine, dedicated to the care and the advancement of care of critically ill patients with neurosurgical or neurological diseases. Neurocritical care patients are heterogeneous, in both their disease process and the therapies they receive, however, several studies demonstrate that care of these patients in dedicated NeuroIntensive Care Units (neuroICUs) by neurointensivists, who coordinate their care is associated with reduced mortality and resource utilization. NeuroICUs foster innovation, and yet despite all the recent advances, much research needs to be undertaken in neurocritical care to better understand the disease pathophysiology and to demonstrate improved outcome with the use of goal-directed therapy based on evolving techniques and therapies.
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The science of nursing has long been discussed as a blending of the art and science of caring, and nursing research builds the evidence of support for nursing practice. Nurses and nursing care are key to successful neurocritical care research endeavors. ⋯ Within the scope of nursing research, the priorities for research in neurocritical care should support this goal. In this manuscript, we discuss what we believe are the priorities of neurocritical care nursing research, the obstacles, and some possible solutions.