Neurosurgical Critical Patients Research Articles

Effect of plan-do-check-active method combined with air pressure wave therapy on the prevention of deep venous thrombosis in critically ill patients in neurosurgery

Deep vein thrombosis (DVT) is prone to occur in the recovery of critically ill neurosurgical patients, increasing economic and psychological pressure, and even endangering life. Plan-Do-Check-Action (PDCA) cycle is a kind of quality management cycle procedure, which can help DVT treatment correctly understand the cause of disease and take effective preventive and nursing measures. The air wave pressure therapy instrument takes pressure therapy as the core, forming circulating pressure on limbs and tissues, promoting the flow of blood and lymph, improving the effect of microcirculation, accelerating the return of limb tissue fluid, and preventing thrombosis and limb edema. A total of 98 critical neurosurgery patients were selected as the study subjects. On the basis of PDCA circulation treatment, the patients were treated with air pressure wave for 30 minutes/time, twice/day and 14 days. Before and after treatment, the indexes of coagulation function, hemorheology (plasma viscosity, whole blood high shear viscosity and whole blood low shear viscosity), lower limb circumference (15 cm above and below the patella) and Barthel index (BI) scores were observed and recorded. DVT was observed by vascular Doppler ultrasound before and after treatment, and the incidence was calculated. The prothrombin time (18.09 s) and thrombin time (17.66 s) after treatment were higher than those before treatment (12.98 s, 130.7 s), and fibrinogen decreased (4.21 vs. 3.31 g/L). The hemorheological indexes of the patients after treatment were plasma viscosity (1.49 mPa/s, 10.8 mPa/s), whole blood high shear viscosity (6.34 mPa/s, 4.47 mPa/s), whole blood low shear viscosity (9.89 mPa/s, 6.32 mPa/s), circumference at 15 cm below the patella (52.29 cm, 45.23 cm), and circumference at 15 cm above the patella (36.17 cm, 31.38 cm). The BI score showed that the number of patients with severe dependence on grade A (46/15) and moderate dependence on grade B (50/14) decreased after treatment, and the average BI score of patients with combined treatment increased (43.87 and 79.86). After treatment, the number of patients with DVT (20/4) and the incidence of DVT (20.40816327%, 4.081632653%) decreased significantly (P<0.05). PDCA circulation combined with barometric wave therapy can significantly improve DVT in critical neurosurgical patients.

Stress hyperglycemia and glycemic control in critical neurosurgical patients: A retrospective study

Stress hyperglycemia and glycemic control in critical neurosurgical patients: A retrospective study

Outcome of Early versus Late Tracheostomy in Neurosurgical critical Patient

The Study was conducted to evaluate the effectiveness of early tracheostomy and of late tracheostomy in neurosurgical critical patients. A retrospective chart review of Neurosurgical critical patients who underwent Tracheostomy from September 2017 to March 2019. Patients were divided into two groups: early tracheostomy occurring within 7 days and late tracheostomy after 7 days of mechanical ventilation. Two groups were compared in terms of days under ventilation, Complication and outcome. There were 30 patients over 18 month period. Age range from 18years to 86 years with means of 52.93±16.59 years. Male: Female ratio was 3:1. 12 (40%) had Early tracheostomy (ET) and 18 (60%) had Late tracheostomy (LT). Day on ventilation on ET group was 14.8±10.25 while on LT group was 20±8.4.Procedure related complication were more common in Late tracheostomy group with 11.11% and 16.66% tracheostomy site hematoma and pneumonia respectively, and subcutaneous emphysema were 8.33% of LT versus a 5.55% of ET, Stomal site infection were 11.11% in late tracheostomy versus 8.33% in ET. Early tracheostomy compare to late tracheostomy reduces the days on Mechanical ventilation, the ICU length of stay, hospital stay and procedural related complication, but it does not affect the mortality rate.

Application of bundle care in artificial airway management in critical neurosurgical patients

Objective To explore the effects of bundle care protocols on artificial airway management in critical neurosurgical patients. Methods Totally 100 critical neurosurgical patients with artificial airways from June 2017 to June 2018 were selected by convenient sampling and divided into the observation group (n=50) and the control group (n=50) according to the random number table. Patients in the control group received conventional nursing care, while patients in the observation group received bundle care. The pulmonary infection rate, comfort and average length of hospital stay were compared between the two groups. Results The pulmonary infection rate of the observation group was 8%, while that of the control group was 24% (χ2=4.762, P<0.05) ; the comfort rate of the observation group was 64%, while that of the control group was 30% (χ2=11.60, P<0.01) ; the length of hospital stay of the observation group was (14.34±2.88) d, whereas that of the control group was (17.28±2.70) d (t=20.617, P<0.01) . Conclusions The bundle care protocol can reduce the incidence of infection and the length of hospital stay and improve the comfort among critical neurosurgical patients. Key words: Neurosurgery; Critical diseases; Artificial airway; Bundle management; Pulmonary infection

A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients.

Intracranial pressure (ICP) monitoring is now widely used in neurosurgical critical patients. Besides mean ICP value, the ICP derived parameters such as ICP waveform, amplitude of pulse (AMP), the correlation of ICP amplitude and ICP mean (RAP), pressure reactivity index (PRx), ICP and arterial blood pressure (ABP) wave amplitude correlation (IAAC), and so on, can reflect intracranial status, predict prognosis, and can also be used as guidance of proper treatment. However, most of the clinicians focus only on the mean ICP value while ignoring these parameters because of the limitations of the current devices. We have recently developed a multimodality monitoring system to address these drawbacks. This portable, user-friendly system will use a data collecting and storing device to continuously acquire patients' physiological parameters first, i.e., ABP, ICP, and oxygen saturation, and then analyze these physiological parameters. We hope that the multimodality monitoring system will be accepted as a key measure to monitor physiological parameters, to analyze the current clinical status, and to predict the prognosis of the neurosurgical critical patients.

A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

Application of bedside ultrasound in measuring gastric residual volume in neurosurgical critical patients with enteral nutrition support

Objective: To explore the effect of bedside ultrasound in measuring gastric residual volume in neurosurgical critical patients with enteral nutrition support. Method: From March to August 2016, 70 critically neurological patients with continues enteral nutrition who admitted in Intensive Care Unit (ICU) were randomized into two groups. The observation group applied the bedside ultrasound monitoring gastric residual volume every day to guide the implementation of enteral nutrition. The control group used syringes withdrawing every 8 hours to measure the gastric residual volume. Results: There was no statistically significant difference in the incidence of complications include regurgitation and aspiration in this two group patients (P=0.356; P=1.000), while the times of interrupting enteral nutrition was lower in the observation group(25.7% vs 5.7%, 74.3% vs 94.3%, P=0.045), the length of target feeding time and the length of ICU stay, the operation time was shortened, with a statistically significant difference[(2.37±0.69) d vs (3.49±0.74) d, P=0.028; (8.52±5.45) d vs (6.40±2.71) d, P=0.022; (58.29±11.22)s vs (67.60±7.05) s, P=0.000]. Conclusion: The application of bedside ultrasound to measure gastric residual volume can be a scientific method to guide enteral nutrition in neurosurgical critical patients, which can reduce the times of interrupting enteral nutrition and shorten the length of target feeding time and ICU length of stay, reduce the workload of nurses.

Perioperative management and surgical treatment of neurosurgical critical patients with thrombocytopenia

To study the perioperative management and surgical treatment of patients with neurosurgical critical diseases and thrombocytopenia. Eleven patients with the diagnosis of neurosurgical critical diseases and thrombocytopenia who received surgical treatment in Department of Neurosurgery, Peking Union Medical College Hospital from 2010 to 2015 were reviewed retrospectively. All eleven patients received platelet transfusions preoperatively. The safety and efficacy of surgical treatment were analyzed by GOS score at 6 months after operations. Platelet counts of six patients who received minimally invasive surgery reached 80×10(9) /L by platelet transfusions preoperatively. Platelet counts of five patients who received Craniotomy and ventriculoperitoneal shunt reached 100×10(9) /L by platelet transfusions preoperatively. Eight patients received platelet transfusions postoperatively according to a low platelet count 24 hours after operations. Two patients died after surgery and one died after discharge. All other eight survival patients got well recovery with an average GOS score of 4.5 at six months after operations. Patients with neurosurgical critical diseases and thrombocytopenia could receive surgical treatment in collaboration with relative departments.

Application of B-ultrasound monitoring plus gastric insufflation for nasointestinal tube indwelling in critical neurosurgical patients

To explore the application of B-ultrasound monitoring plus gastric insufflation for nasointestinal tube indwelling in critical neurosurgical patients. A total of 96 critical comatose neurosurgical patients indicated for nasointestinal tube indwelling were randomized into three groups of routine (A, n = 32), gastric insufflation (B, n = 31) and B-ultrasound monitoring plus gastric insufflation (C, n = 33). And the position of nasointestinal tube was observed within 24 h and at 72 h in three groups. The general profiles of three groups showed no significant differences (P > 0.05). The proportions of nasointestinal tube passing pylorus within 24 h in three groups were 43.8%, 74.2% and 93.9% respectively. Comparing group C with groups A and B, the differences presented statistical significance. The proportions of nasointestinal tube passing pylorus at 72 h in three groups were 68.8%, 83.9% and 100% respectively. Comparing group C with groups A and B, the differences had statistical significance. Refined method of nasointestinal tube indwelling and B-ultrasound monitoring may boost the rate of successful indwelling.It is worth wider promotion and application.

Application value of medical collaborative mode in nursing management to cope with neurosurgical critical patients

Objective To explore the application value of collaborative mode in nursing management to cope with neurosurgical critical patients and provide evidence for clinical management. Methods A total of 200 critical patients had been divided into control group (traditional nursing management) and experimental group (medical collaborative management) on average during January 2013 to 2014 by random number table. We compared the quality of nursing, satisfaction of medical staffs and patients, and nurse′s self-efficacy. Results The scores of ward management, basic nursing, specialized nursing, responsibility management, communication in the experimental group were (17.34±2.23), (18.00±1.65), (18.11±1.23), (17.25±2.43), (18.21±1.54) compared with (16.11±2.12), (13.43±2.44), (16.65±2.34), (15.45±2.22), (16.46±1.31) in the control group (t=4.123, 5.653, 4.845, 5.324, 4.345, respectively; P<0.05). The satisfaction scores of physicians, nurses and patients in the experimental group were 90.0%, 96.7%, 98.0%, respectively while these rate in the control group were 50.0%, 76.7%, 92.5% (χ2=3.810, 5.192, 6.687; P<0.05). The incidence of medical contradiction in the experimental group was 4 cases (4.0%) lower than 12 cases (12.0%) in the control group. The difference was statistically significant (χ2=4.348, P=0.037). The total score of nurses′ initiative, responsibility, self-confidence, communication skills, problem solving ability, self-efficacy were (7.43±1.65), (7.25±1.65), (7.65±1.76), (7.65±1.98), (8.76±1.65), (36.34±2.44) respectively higher than those (5.55-1.65), (5.34±1.65), (5.54±1.56), (5.87±1.87), (5.87±1.43), (30.54±3.34) in the control group. The difference was statistically significant (t=4.542, 5.545, 4.765, 4.234, 6.065, 4.534, respectively; P<0.05). Conclusions The medical collaborative mode not only meets the diversification of the patient′ demands, builds a good relationship between the doctors, patients and nurses, but also improves the quality of nursing. Key words: Neurosurgery Department; Nursing management; Medical collaborative management; Application value

Evaluation of vitamin D level in patients from neurosurgical intensive care unit.

Vitamin D plays an important role in maintaining normal bone metabolism. Recent studies have suggested that vitamin D influences many other physiological processes, including muscle function, cardiovascular homeostasis, nerve function, and immune response. Furthermore, accumulated evidence suggests that vitamin D also mediates the immune system response to infection. Critical neurosurgical patients have higher infection and mortality rates. To correlate vitamin D deficiency to the immunological status of neurosurgical intensive care unit patients, we detected serum vitamin D level in 15 patients with clinically suspected infection and 10 patients with confirmed infection. Serum level of 25-hydroxyvitamin D, the primary circulating form of vitamin D, was significantly decreased in patients with suspected or confirmed infection after a 2-week neurosurgical intensive care unit hospitalization, while serum level of 1,25-dihydroxyvitamin D, the active form of vitamin D, was significantly decreased in patients after a 4-week neurosurgical intensive care unit hospitalization. These findings suggest that vitamin D deficiency is linked to the immunological status of neurosurgical intensive care unit patients and vitamin D supplementation can improve patient's immunological status.

Resource utilization in the management of traumatic brain injury patients in a critical care unit: An audit from a rural set-up of a developing country

Background:Neurosurgical patients including patients with severe head injury are at risk of developing respiratory complications. These can adversely affect the outcome and can result in poor survival. Many studies confirm that tracheostomy is a safe, effective method of airway management for patients with severe head, facial and multisystem organ trauma.Aims:To know the indications for performing early tracheostomy and its outcome.Settings and Design:Retrospective data analysis.Materials and Methods:The present study is a retrospective analysis of all patients who were admitted with the diagnosis of head injury between January 2007 and December 2009 and underwent tracheostomy at a rural tertiary care trauma center of Central India.Results:During the study period, a total of 40 patients with head injury underwent tracheostomy. All the patients sustained head injury in road traffic accidents. The mean age of the patients was 37.6 years (range 14–75 years, standard deviation 14 ± 14.9 years). Maximum number of patients were in their third decade of life, followed by those in the fifth and fourth decades. There were 36 males and 4 females. Tracheostomy was performed in 30 patients with severe head injury, 9 patients with moderate head injury and in only one case of mild head injury as the patient had multiple facial injuries compromising the airway.Conclusions:Neurocritical care is a relatively new field in India, and the facilities for critical neurosurgical patients are available only in a very few tertiary care centers mainly serving the urban areas. In the present study, we discuss our limited experience with tracheostomy in patients with head injury while facing the challenge of limited resources.

Safety and Efficacy of Intensive Insulin Therapy in Critical Neurosurgical Patients

Survey of Anesthesiology: December 2009 - Volume 53 - Issue 6 - p 257-258 doi: 10.1097/01.SA.0000360628.41394.3c

2009 in Review

2009 in Review

Safety and Efficacy of Intensive Insulin Therapy in Critical Neurosurgical Patients

Intensive insulin therapy to maintain blood glucose at or below 6.11 mM reduces morbidity and mortality after cardiac surgery and morbidity in medical intensive care unit (ICU) patients. The authors investigated the clinical safety and outcome effects of intensive insulin therapy compared to conventional insulin therapy in patients receiving postoperative intensive care after neurosurgical procedures. In this prospective randomized controlled trial, 483 patients undergoing elective or emergency brain surgery were prospectively and randomly assigned either to intensive insulin therapy (241 patients), receiving insulin titrated to maintain blood glucose levels within the range of 4.44-6.11 mM, or to conventional insulin therapy (242 patients), receiving insulin to maintain blood glucose levels below 11.94 mM. Primary endpoint was incidence of hypoglycemia (defined as blood glucose < 2.78 mM). Efficacy measures included the length of ICU stay, infection rate, and 6 months follow-up Glasgow outcome scale score and overall survival. Hypoglycemia episodes were more frequent in patients receiving intensive insulin therapy, median (min-max): 8 (0-23) versus 3 (0-4); P < 0.0001. The length of stay in the ICU was shorter (6 vs. 8 days; P = 0.0001), and the infection rate was lower (25.7% vs. 39.3%; P = 0.0018). Glasgow outcome scale score and overall survival at 6 months were similar in the two groups. Intensive insulin therapy in patients admitted to a postoperative neurosurgical ICU after brain surgery is associated with iatrogenic hypoglycemia, but it can also reduce the infection rate and shorten the ICU stay.

The Camino intracranial pressure device in clinical practice. Assessment in a 1000 cases

Intracranial pressure (ICP) monitoring has become standard in the management of neurocritical patients. A variety of monitoring techniques and devices are available, each offering advantages and disadvantages. Analysis of large populations has never been performed. A prospective study was designed to evaluate the Camino fiberoptic intraparenchymal cerebral pressure monitor for complications and accuracy. Between 1992-2004 one thousand consecutive patients had a fiberoptic ICP monitor placed. The most frequent indication for monitoring was severe head injury (697 cases). The average duration of ICP monitoring was 184.6 +/- 94.3 hours; the range was 16-581 hours. Zero drift (range, -17 to 21 mm Hg; mean 7.3 +/- 5.1) was recorded after the devices were removed from 624 patients. Mechanical complications such as: breakage of the optical fiber (n = 17); dislocations of the fixation screw (n = 15) or the probe (n = 13); and failure of ICP recording for unknown reasons (n = 4) were found in 49 Camino devices. The Camino ICP sensor remains one of the most popular ICP monitoring devices for use in critical neurosurgical patients. The system offers reliable ICP measurements in an acceptable percentage of device complications and the advantage of in vivo recalibration. The incidence of technical complications was low and similar to others devices.