The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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Multicenter Study
Pupillary Light Reflex Variability as a Predictor of Clinical Outcomes in Subarachnoid Hemorrhage.
A change in the pupillary light reflex (PLR) is a sensitive indicator for detecting expanding intracranial lesions. Changes in PLR may be a prognostic marker for patients with intracranial lesions. The purpose of this analysis was to explore how PLR readings, size, constriction velocity (CV), dilation velocity (DV), Neurologic Pupil Index (NPi), and latency predict clinical outcome in patients with subarachnoid hemorrhage. ⋯ Patients with higher WSD PLR values showed better outcomes (ie, lower mRS at discharge), suggesting that patients with narrower WSD PLR are at a higher risk for poor outcomes.
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Multicenter Study Comparative Study
Monitoring and sedation differences in the management of severe head injury and subarachnoid hemorrhage among neurocritical care centers.
The emergence of specialized neurocritical care (NCC) centers has been associated with an improved survival of patients with severe traumatic brain injury or subarachnoid hemorrhage. However, there are no established guidelines on sedation strategy or the frequency of evaluating the level of consciousness using the neurological wake-up test (NWT) in sedated NCC patients. ⋯ Although Scandinavian countries have similar healthcare systems, there were marked differences among the participating NCC centers in the choice of monitoring tools and sedatives and the routine use of the NWT. These differences likely reflect different clinical management traditions and a lack of evidence-based guidelines in routine NCC.
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Multicenter Study Observational Study
Significant practice pattern variations associated with intracranial pressure monitoring.
The purpose of this study was to describe nursing practice in the care of patients with intracranial pressure monitoring. Although standards for care of such patients have been established, there continue to be variations in the nursing practice. ⋯ For more insights from the authors, see Supplemental Digital Content 1, at http://links.lww.com/JNN/A7.
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Randomized Controlled Trial Multicenter Study
Multicenter pilot study: safety of automated chest percussion in patients at risk for intracranial hypertension.
In the critical care setting, the focus of care during the first few weeks following acute brain injury is prevention of secondary brain injury by optimizing cerebral perfusion. Ensuring adequate oxygenation and perfusion of cerebral tissues requires attention to all of the body systems. Chest percussion therapy (CPT) promotes pulmonary hygiene and optimizes gas exchange by opening the alveoli. ⋯ Each patient was randomized to receive automated CPT (using specialty beds) for 10 minutes, starting at 10, 20, 30, or 40 minutes into the hour. There were no differences in mean ICP values before, during, or after CPT. This study provides evidence that it is safe to perform CPT in patients with ICP monitoring in situ.
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Multicenter Study Comparative Study
A study of pupillary assessment in outpatient neurosurgical clinics.
This study compared the accuracy of three methods of assessing pupil diameter Measurements from the ForSite pupillometer and visual assessments were compared with measurements obtained using a pupil gauge (the standard method). Two sets of measurements were obtained from 65 out-patients at four neurosurgical clinics. ⋯ We conclude that the ForSite pupillometer is an easy-to-use and accurate measure of pupil diameter in a clinic setting. It may be more accurate than the pupil gauge.