Articles: neurocritical-care.
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Multicenter Study
Teleneurocritical Care for Patients with Large Vessel Occlusive Ischemic Stroke Treated by Thrombectomy.
Teleneurocritical care (TNCC) provides 24/7 virtual treatment of patients with neurological disease in the emergency department or intensive care unit. However, it is not known if TNCC is safe, effective, or associated with similar outcomes compared with in-person neurocritical care. We aim to determine the effect of daily inpatient consults from TNCC on the outcomes of patients with large vessel occlusive acute ischemic stroke treated by thrombectomy. ⋯ Teleneurocritical care allows for equivalent favorable functional outcomes compared with in-person neurocritical care for patients with acute large vessel ischemic stroke receiving thrombectomy. The standardized protocols used by TNCC in this study, specifically the comprehensive 24/7 treatment of patients in the intensive care unit for the length of their stay, may be relevant for other health systems with limited in-person resources; however, additional study is required.
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Observational Study
Volatile sedation with isoflurane in neurocritical care patients after poor-grade aneurysmal subarachnoid hemorrhage.
Volatile sedation after aneurysmal subarachnoid hemorrhage (aSAH) promises several advantages, but there are still concerns regarding intracranial hypertension due to vasodilatory effects. We prospectively analyzed cerebral parameters during the switch from intravenous to volatile sedation with isoflurane in patients with poor-grade (World Federation of Neurosurgical Societies grade 4-5) aSAH. ⋯ Isoflurane sedation does not compromise ICP or cerebral oxygenation in poor-grade aSAH patients, but the significant depression of CPP could limit the use of volatiles in case of hemodynamic instability or high vasopressor demand.
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Patients with critical neurological illness are diverse. As a result of the heterogeneity of this patient population, standardized approaches to patient management might not confer benefit. A precision medicine approach to neurocritical care is therefore urgently needed to improve our understanding of neurocritical illness and the care provided to this vulnerable cohort. ⋯ This review summarizes the current state of knowledge on Bayes' theorem, and its potential applications to the field of neurocritical care. We review the basic principles underlying Bayes' theorem, compare the use of Bayesian versus frequentist statistics in medicine, and discuss the relevance of Bayesian statistics to the field of neuroscience and to clinical research. Finally, we explore the potential benefits of employing Bayesian methods within the field of neurocritical care as a steppingstone toward implementing precision medicine approaches to improve patient outcomes for complex, heterogeneous disorders.
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When using an external ventricular drain (EVD) to monitor intracranial pressure (ICP), nurses need to know how long to wait after each manipulation of the transducer before the displayed ICP value represents an accurate signal. This study explores ICP signal equilibration time (EqT) under clinical conditions. ⋯ Even when no additional variables were introduced, the mean EqTs were ~ 30 s. Common clinical variables increase the length of time before a transducer connected to an EVD will provide an accurate reading. Nurses should wait at least 30 s after turning the EVD stopcock before assuming ICP value reflects accurate ICP.
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This proceedings article presents the scope of pediatric coma and disorders of consciousness based on presentations and discussions at the First Pediatric Disorders of Consciousness Care and Research symposium held on September 14th, 2021. Herein we review the current state of pediatric coma care and research opportunities as well as shared experiences from seasoned researchers and clinicians. Salient current challenges and opportunities in pediatric and neonatal coma care and research were identified through the contributions of the presenters, who were Jose I. ⋯ Boerwinkle, MD, with overview by Mark Wainwright, MD, and subsequent audience discussion. The program, executively planned by Varina L. Boerwinkle, MD, Mark Wainwright, MD, and Michelle Elena Schober, MD, drove the identification and development of priorities for the pediatric neurocritical care community.