Head Elevation Research Articles

Hand dynamometer and clinical tests to evaluate the recovery of neuromuscular conductance in atracurium versus rocuronium in patients undergoing laparoscopic surgery

Background. Postoperative muscle weakness is not unusual and may be related to postoperative complications in patients after general anesthesia. However, the clinical practice of neuromuscular conductance monitoring is uncommon among anesthesiologists.The objective was to evaluate the rate of neuromuscular recovery after atracurium and rocuronium and to determine the numerical value of grip strength using a hand dynamometer, indicating the safety of transferring a patient from the postoperative ward.study design. A prospective, observational, clinical comparison study.Materials and Methods. Upon proper authorization and approval from the local ethics committee, patients referred for laparoscopic surgery, 120 patients of the American Society of Anesthesiology (ASA) physical status I &II between ages 20–49 years were randomly assigned into 2 groups of 60 each. Group I received a single atracurium dose of 0.5mg/kg of ideal body weight and Group II patients received a single rocuronium dose of 0.6mg/kg of ideal body weight. Parameters such as modified Alderete score (MAS), grip strength, and sustained head and leg lift for five seconds were compared in both groups 50 minutes after giving the reversal agent at 10-minute intervals.Results. Postoperative muscle recovery (grip strength) was faster in the atracurium group than the rocuronium group, with a p-value of 0.042 at 20 minutes, and 0.0000 for 30, 40, and 50 minutes after giving the reversal agent. The time to obtain a modified Alderete score (MAS) > 8 scores was statistically insignificant with a p-value of 0.335. Positive clinical test for sustained head lift for 5 seconds was statistically insignificant within a majority of the time, except in the 20 minutes, most of the cases in the atracurium group were able to sustain head elevation for 5 seconds with a p-value of 0.021. In the 10 &20 minutes, most cases in the atracurium group could sustain leg elevation for 5 seconds with a p-value of 0.015 and 0.014 respectively. However, most cases in both groups could sustain head and leg elevation for 5 seconds in the 30 minutes after giving a reversal agent.Conclusion. Compared to rocuronium, atracurium has been associated with faster muscle recovery after a single tracheal intubation dose for a short surgery. This was determined by utilizing an electronic hand dynamometer to measure grip strength. 42% grip strength from baseline might be applicable for safe discharge from the recovery room. A hand dynamometer assessment revealed more post-operative muscle weakening than a clinical evaluation.

Comparison of third-generation minimally invasive surgery, split-drill osteotomy, and triplanar chevron osteotomy for treating mild to moderate hallux valgus with metatarsalgia in middle-aged women: An observational study.

This retrospective study compared the clinical efficacy of third-generation minimally invasive surgery (3rd-MIS) split-drill osteotomy with soft tissue release to that of triplanar chevron osteotomy (TCO) for treating mild to moderate hallux valgus (HV) with metatarsalgia in middle-aged women. This study compared the efficacy of 3rd-MIS using split-drill osteotomy to that of TCO in treating mild to moderate HV with metatarsalgia in 52 middle-aged women from March 2022 to June 2023. Retrospectively analyzing a total of 52 patients (26 patients per group), we employed 2 distinct surgical methods across 2 groups in this study: the TCO group received a traditional TCO accompanied by soft tissue release, whereas the MIS group underwent a split-drill osteotomy with soft tissue release. The study compared the operation time, onset of weight-bearing, osteotomy healing, blood loss, pre- and postsurgery X-ray measurements, metatarsalgia, and foot function scores. In the TCO group, complications included peri-incisional numbness, elevation of the first metatarsal head with metatarsalgia, and bone hyperplasia with stiffness at the MTPJ in one patient each. In the MIS group, bunions were successfully corrected without significant complications like bone nonunion or avascular necrosis of the metatarsal head, and the metatarsal length was preserved. Significant differences in operation time, weight-bearing onset, healing, and blood loss were detected between groups (P < .05). Preoperatively, there were no significant differences in hallux valgus angle, 1-2 intermetatarsal angle, or distal metatarsal articular angle among the groups (P > .05). Nonetheless, notable postoperative differences were observed (P < .05). Foot function and pain scores, assessed by the American Orthopaedic Foot & Ankle Society and the Visual Analogue Scale, showed significant improvements in both groups following surgery. Both surgical techniques effectively corrected the HV angle without significant changes in the first metatarsal length. The MIS group experienced significantly less pain on the second day postsurgery, as indicated by lower Visual Analogue Scale scores (P < .05). Both techniques were similarly effective in treating metatarsalgia. 3rd-MIS split-drill osteotomy with soft tissue release offers several advantages over TCO techniques for treating mild to moderate HV with metatarsalgia in middle-aged women, such as reduced trauma, quicker healing, smaller scars, and less pain after surgery.

Elevating Prehospital Traumatic Brain Injury Care: A Comparative Analysis of Civilian and Military Air Transport Guidelines

ObjectiveTraumatic brain injuries (TBIs) are a leading cause of death and disability worldwide. Establishing TBI guidelines is crucial for prehospital management. Civilian medical practices are often influenced by military trauma guidelines. This study provides a comparative analysis of prehospital TBI management by a civilian air medical evacuation service using civilian guidelines and military clinical practice guidelines from the Joint Trauma System of the Department of Defense. MethodsA retrospective review of 100 deidentified patient transport logs from a prominent civilian air medical service was conducted. The logs were compared with the service's patient care guidelines and the 2023 Joint Trauma System Clinical Practice Guidelines. Data were analyzed for adherence to 14 metrics. ResultsPatients showed improvement in preflight and postflight Glasgow Coma Scale scores and were managed according to recommendations on head elevation, oxygenation, blood pressure, and temperature by both organizations. Discrepancies between guidelines included differences in the management of ventilator settings, blood pressure, oxygenation, temperature, serum glucose, intracranial hypertension, suspected brain herniation, serum sodium levels, and seizure prophylaxis. ConclusionComparing civilian and military guidelines highlights areas for potential improvements in TBI management, such as integrating advanced monitoring and the implementation of (i-STAT, Abbott Laboratories, Chicago, IL) testing in air transport to enhance patient care and outcomes.

The Relationship Between the Triple Airway Maneuver Insertion Technique and The Success Rate of Laryngeal Mask Airway Installation in Elective Surgery

Background: The Laryngeal Mask Airway (LMA) is a widely utilized supraglottic airway device by anesthesiologists in selective procedures, particularly in cases where intubation is not feasible or when managing a difficult airway. Complicating factors such as a short neck and large tongue can hinder LMA insertion, necessitating the use of the Triple Airway Maneuver (TAM). This technique involves a combination of head elevation, anterior mandible lift, and mouth opening to facilitate airway clearance. Purpose: This study was to evaluate the relationship between the TAM technique and the success rate of LMA insertion during elective surgeries at Dr. Soedirman Kebumen General Hospital. Methods: A cross-sectional, analytic study was conducted in June 2024, involving 52 respondents selected via purposive sampling. Data were collected using observation sheets. Findings: The findings revealed that the majority of respondents were aged 17-25 years (38.5%) and had a body mass index of 18.5-25.0 (73.1%). Non-smokers constituted 73.1% of the sample, while 46.2% had occupations involving repetitive neck movements. The TAM group achieved 45 successful LMA insertions, with 44 succeeding on the first attempt and 1 on the second, compared to 7 successful insertions in the non-TAM group. However, Kendall’s tau c test (p=0.056) indicated no statistically significant relationship between TAM and LMA insertion success rates, and the correlation coefficient (0.385) suggested a weak relationship. Conclusions: the TAM technique does not significantly influence the success rate of LMA insertion

Optimizing Traumatic Brain Injury Recovery: Exploring the Advantages and Results of Decompressive Craniectomy.

Traumatic brain injury (TBI) causes significant mortality and morbidity across regions, imposing a substantial socioeconomic burden on societies. A major complication that can arise is uncontrolled intracranial pressure (ICP). Several strategies exist for reducing ICP in TBI patients, including head elevation, mannitol administration, and hyperventilation. Decompressive craniectomy (DC) is a therapeutic approach employed to lower ICP. This technique offers immediate and permanent relief from elevated ICP, although there are ongoing debates regarding its beneficial use and appropriate indications for patients with increased ICP. The objective of this review was to assess variations in surgical technique, timing of the procedure, and patient characteristics associated with DC. Through the evaluation of clinical and radiologic data concerning DC in patients with elevated ICP, it was revealed that while DC provides numerous benefits, it also carries a significant risk of mortality and morbidity. Furthermore, we observed that factors such as age, initial Glasgow Coma Scale (GCS) score, pupil response, and the time interval between injury and DC can serve as predictors for the procedure's outcomes. Based on our findings, we recommend conducting further trials to shed light on the use of DC in TBI patients.

Cognitive and motor improvement by tummy time practice in preemies from low-income settings: a randomized clinical trial.

Early intervention and parental education for preemies are limited in some low-income countries. Thus, this study aimed to assess whether daily tummy time (TT) associated with usual care (UC) enhances motor and cognitive development in preemies from low-income countries. The main and secondary aim was to assess prone head elevation (PHE) and motor and cognitive functions, respectively. Thirty-one preemies with a mean gestational age at birth of 33.3 ± 1.6 weeks and weighing <2,500 g were included and 18 completed all assessments. Parents from the TT group were asked to perform TT with their preemies for at least 20 min during daily activities and playtime. Motor and cognitive functions were assessed by a blinded examiner using the motor and cognitive composite scores of Bayley-III after two and four months of corrected age. PHE was given by the angle from the tragus of the ear to the supporting surface of the infant; measurements were obtained using the Kinovea® software at baseline, after two, three, and four months of corrected age. The Bayley-III motor composite score of the TT group was higher than the UC group after two and four months of corrected age. The PHE angle increased over time but did not differ between groups. Nevertheless, TT expanded the perspective of preemies to explore their bodies and environment, favoring the stimuli for motor and cognitive patterns. The loss of participants (31%) was one of the limitations of the study, illustrating the challenge of providing continued early interventions to preemies from low-income countries. In this sense, TT practice is a home intervention that may improve motor and cognitive function of preemies immediately after hospital discharge.

Nursing Care in Mild Brain Injury Patients on Intracranial Adaptive Capacity Reduction Diagnosis

Introduction: Head injury or Traumatic Brain Injury (TBI) is defined as a disturbance in the normal functioning of the brain that can be caused by a collision, blow, or jolt to the head or a penetrating head injury. Decreased intracranial adaptive capacity is a disturbance of the intracranial dynamics mechanism in compensating for stimuli that can reduce intracranial capacity. This study aims to explore nursing problems in clients with mild brain injury. Methods: This study uses a case report research design. The population in this study were patients admitted to the roudloh room with mild brain injury as many as 4 people. The sample was selected using purposive sampling technique and obtained a sample of 2 patients with a nursing problem of decreased intracranial adaptive capacity. Data collection using surgical medical nursing assessment format. Data was analyzed with descriptive analitic. Results: The assessment results found that both patients experienced headaches, vertigo, nausea and vomiting and blurred vision. The nursing problem raised is a decrease in intracranial adaptive capacity. The intervention given is to provide a 30⁰ head elevation. From the results of the intervention, it was found that the intervention had been resolved. Conclusion: Giving semi fowler position with head elevation 30 ° in patients with nursing problems decreased intracranial adaptive capacity is very effective. The provision of interventions provided for 3 days with a 30 ° head elevation showed that both patients achieved outcome. Keywords: Mild Head Injury, Head Elevation 30⁰, Head Injury

Results of transosseous suture fixation in four-part valgus impacted fractures of the proximal humerus

BackgroundThe osteonecrosis ratio in valgus impacted fractures of the proximal humerus is low (<10 %), giving osteosynthesis all its meaning. However, the optimal fixation technique remains controversial. After recentering the humeral head, osteosuture is stable enough to allow bone healing in an adequate position as well as a good long-term shoulder functionality. MethodsOur cohort included 22 patients with a mean age of 65 (28–83). Patients were placed in a beach-chair position. Surgical exposure was done through an anterolateral, transdeltoid approach. Stay sutures were placed on both tuberosities. Elevation of the humeral head was obtained for 9 patients using iliac crest bone graft, for 7 patients using bone substitutes, for 6 without any graft needed. Both tuberosities were approximated and tied together using two horizontal non-absorbable double-threaded sutures. The whole head was also tied to the humeral metaphysis by cerclage wiring using the same suture. Patients were immobilized in a sling for 4 weeks with no passive or active mobilization; then began rehabilitation starting with passive and active-assisted mobilization. Functional outcome was assessed with the Constant score. Radiographic follow-up was used for fracture healing and osteonecrosis signs. ResultsAll fractures united within the first 3 months. One patient had radiographic signs of osteonecrosis and one had a secondary displaced fracture without osteonecrosis. At an average follow-up of 35 months, the median Constant score was 83.7 % (63–100) in comparison to the uninjured side. DiscussionA preserved posteromedial periosteal hinge in a valgus impacted fracture of the proximal humerus is key to the success of osteosuture. This hinge provides mechanical stability to the humeral head once elevated, as well as blood-supply from the branches of the posterior circumflex humeral artery. Computed Tomography with Three-Dimensional reconstructed images allow for a precise analysis of this hinge as well as the vascularity of the humeral head. Osteosuture being a minimally invasive surgical procedure plays a predominant role in sparing the remaining vascularization of the humeral head. ConclusionOsteosuture in four-part valgus impacted fractures of the proximal humerus is a minimally invasive procedure as well as a reliable technique yielding good long-term results.

Study of effect of head elevation in PROSEAL laryngeal mask airway insertion at a tertiary hospital

Background &amp; Aims: Proseal Laryngeal Mask Airway (PLMA) is a supra-glottic airway device that prevents gastric insufflation and pulmonary aspiration. In the present study, we intend to determine the effect of head elevation in PLMA insertion. Methodology: The present study was a single-center, comparative, interventional study, conducted in patients of 18-60 years of age, either gender, American Society of Anaesthesiologists (ASA) grade I-II, patients posted for elective surgical procedures under general anaesthesia. 123 adult patients were randomized into three groups using a random number table. Group C: No head elevation (No pillow), Group LP: 4 cm head elevation (4 cm pillow), and Group HP: 8 cm head elevation (8 cm pillow). Results: PLMA insertion at first attempt was successful in 30 patients (73.17%) in Group C, 40 patients (97.56%) in Group LP &amp; 22 patients (53.66 %) in Group HP, the difference was statistically significant (P &lt;0.001). The mean insertion time of LMA in Group C, Group LP, and Group HP was found to be 21.90 ± 4.48s, 16.12 ± 5.35s, and 25.14 ± 8.79s respectively which was significantly less in Group LP when compared with Group C and Group HP (P&lt; 0.001). The ncidence of blood staining on PLMA was significant in Group HP (20 patients) as compared to Group C (3 patients) &amp; Group LP (2 patients), the difference was statistically significant (P &lt;0.001). Conclusion: A head elevation by a pillow of height of 4 cm was effective for PLMA insertion in adult patients when compared with an 8 cm pillow.

The Potential Effect of Changing Patient Position on Snoring: A Systematic Review.

Approximately 45% of adults snore occasionally, and 25% snore regularly, with a higher prevalence in men and an increase among postmenopausal women due to hormonal changes. Snoring is a health concern linked to vascular disease and decreased quality of life for both snorers and their bed partners. Effective snoring treatment, which aims to reduce or eliminate the sound, is challenging and depends on factors like age, comorbidities, disease severity, and anatomical features. This review aims to provide a systematic overview of the current literature on the effects of positional therapy (PT) on snoring. Various devices facilitate PT, including anti-snoring pillows and vibration alarms. PT devices maintain head and neck alignment to keep airways open, while head of bed elevation (HOBE) solutions reduce upper airway collapses by elevating the head and trunk. Studies show that PT and HOBE reduce snoring by increasing airway cross-sectional area and decreasing closing pressure. Despite their benefits, these non-surgical treatments have limitations, such as discomfort in certain sleeping positions and intolerance to prolonged head elevation. While reducing snoring intensity is critical for health reasons, further comparative studies between the different devices are needed to enhance snoring management.

The Effects of Head Elevation on Intracranial Pressure, Cerebral Perfusion Pressure, and Cerebral Oxygenation Among Patients with Acute Brain Injury: A Systematic Review and Meta-Analysis.

Head elevation is recommended as a tier zero measure to decrease high intracranial pressure (ICP) in neurocritical patients. However, its quantitative effects on cerebral perfusion pressure (CPP), jugular bulb oxygen saturation (SjvO2), brain tissue partial pressure of oxygen (PbtO2), and arteriovenous difference of oxygen (AVDO2) are uncertain. Our objective was to evaluate the effects of head elevation on ICP, CPP, SjvO2, PbtO2, and AVDO2 among patients with acute brain injury. We conducted a systematic review and meta-analysis on PubMed, Scopus, and Cochrane Library of studies comparing the effects of different degrees of head elevation on ICP, CPP, SjvO2, PbtO2, and AVDO2. A total of 25 articles were included in the systematic review. Of these, 16 provided quantitative data regarding outcomes of interest and underwent meta-analyses. The mean ICP of patients with acute brain injury was lower in group with 30° of head elevation than in the supine position group (mean difference [MD] - 5.58mm Hg; 95% confidence interval [CI] - 6.74 to - 4.41mm Hg; p < 0.00001). The only comparison in which a greater degree of head elevation did not significantly reduce the ICP was 45° vs. 30°. The mean CPP remained similar between 30° of head elevation and supine position (MD - 2.48mm Hg; 95% CI - 5.69 to 0.73mm Hg; p = 0.13). Similar findings were observed in all other comparisons. The mean SjvO2 was similar between the 30° of head elevation and supine position groups (MD 0.32%; 95% CI - 1.67% to 2.32%; p = 0.75), as was the mean PbtO2 (MD - 1.50mm Hg; 95% CI - 4.62 to 1.62mm Hg; p = 0.36), and the mean AVDO2 (MD 0.06µmol/L; 95% CI - 0.20 to 0.32µmol/L; p = 0.65).The mean ICP of patients with traumatic brain injury was also lower with 30° of head elevation when compared to the supine position. There was no difference in the mean values of mean arterial pressure, CPP, SjvO2, and PbtO2 between these groups. Increasing degrees of head elevation were associated, in general, with a lower ICP, whereas CPP and brain oxygenation parameters remained unchanged. The severe traumatic brain injury subanalysis found similar results.

Retraction: Management of Impacted Fetal Head at Caesarean Birth.

K. Cornthwaite, R. Bahl, C. Winter, Wright, J. Kingdom, K. Walker, G. Tydeman, A. Briley, M. Schmidt-Hansen, T. Draycott, and the Royal College of Obstetricians & Gynaecologists. Management of Impacted Fetal Head at Caesarean Birth. BJOG. 2023;130(12):e40-e64, https://doi.org/10.1111/1471-0528.17534. The above article, published on June 12, 2023, in Wiley Online Library (Wiley Online Library), has been retracted by agreement between the authors, journal Editor-in-Chief, Aris Papageorghiou, the Royal College of Obstetricians and Gynaecologists, and John Wiley & Sons Ltd. The retraction has been agreed following the retraction of (1), a key paper cited in the above article. The retraction of (1) notes concerns regarding discrepancies between the retrospective trial registration and the published article. In light of this, the Royal College of Obstetricians & Gynaecologists has determined that the data and subsequent results in the above article are now implicated due to the discrepancies found in (1), particularly regarding the benefits of Fetal Pillow in relation to both maternal and neonatal outcomes. Reference: (1) S.L. Seal, A. Dey, S.C. Barman, G. Kamilya, J. Mukherji, and J.L. Onwude, Retracted: "Randomized controlled trial of elevation of the fetal head with a fetal pillow during cesarean delivery at full cervical dilatation," International Journal of Gynecology & Obstetrics 133, no. 2 (2016): 178-182, https://doi.org/10.1016/j.ijgo.2015.09.019.

Compliance to ventilator care bundles and its association with ventilator-associated pneumonia

PurposeVentilator care bundles are effective in the prevention of ventilator-associated pneumonia (VAP). However, the compliance of these bundles in intensive care units (ICUs) remains poorly studied. This study investigates the Medical Information Mart for Intensive Care (MIMIC)-IV cohort’s compliance with the Institute for Healthcare Improvement (IHI) bundle and its resulting association with VAP incidence.MethodsThis is a retrospective cohort study of the MIMIC-IV database. Patients with > 48 h of invasive mechanical ventilation (IMV) were included. Diagnosis of VAP was identified with the International Classification of Diseases (ICD)-9 and ICD-10 codes. Compliance rates to the IHI bundle were extracted. The association of the IHI bundle and its individual interventions with VAP incidence was analyzed with univariate and multivariate analysis.Results8270 patients were included, of which 1328 (16.1%) had VAP. 25 patients (0.3%) had full compliance to the IHI bundle. 137 patients (1.7%) received no interventions from the bundle. Gastroprophylaxis had the lowest (2.1%) while head elevation had the highest (89.3%) compliance rates. In patients receiving the IHI bundle, each additional intervention was associated with lower VAP incidence (OR [odds ratio] = 0.906, 95% CI [confidence interval] 0.847–0.969). Appropriate sedation levels (OR = 0.765, 95% CI 0.661–0.885) and the use of heat and moisture exchanger (HME) filters (OR = 0.862, 95% CI 0.745–0.998) were individually associated with reduced VAP incidence, while active humidification was individually associated with increased VAP incidence (OR = 1.139, 95% CI 1.001–1.296).ConclusionThe use of the IHI bundle was associated with a lower incidence of VAP, but compliance with the bundle was poor. Appropriate sedation and HME filters were individually associated with reduced VAP incidence. Better compliance with the IHI bundle may reduce VAP rates in mechanically ventilated patients.Graphical

Patient positioning and its impact on perioperative outcomes in children: A narrative review.

Patient positioning interacts with a number of body systems and can impact clinically important perioperative outcomes. In this educational review, we present the available evidence on the impact that patient positioning can have in the pediatric perioperative setting. A literature search was conducted using search terms that focused on pediatric perioperative outcomes prioritized by contemporary research in this area. Several key themes were identified: the effects of positioning on respiratory outcomes, cardiovascular outcomes, enteral function, patient and carer-centered outcomes, and soft issue injuries. We encountered considerable heterogeneity in research in this area. There may be a role for lateral positioning to reduce respiratory adverse outcomes, head elevation for intubation and improved oxygenation, and upright positioning to reduce peri-procedural anxiety.

Comparision between 3% Hypertonic Saline and 20% Mannitol in the Management of Raised Intracranial Pressure in Children

Background Osmotic agents like mannitol and hypertonic saline are the mainstay of management of raised intracranial pressure (ICP) along with non-pharmacological measures like head elevation, hyperventilation, and hypothermia and CSF drainage. Several recent studies have shown hypertonic saline relatively superior to mannitol however, both are being used commonly. So, this study was done to compare the efficacy of mannitol and hypertonic saline in management of raised ICP in children. Methods This was a prospective randomized comparative study done among 40 children aged 1-5 years admitted in department of Pediatrics and Adolescent Medicine, BPKIHS, Dharan with clinical signs and symptoms of raised ICP They were divided into two groups based on consecutive sampling with group 1 receiving 20% mannitol and group 2 receiving 3% hypertonic saline. Results Both the groups were comparable for age distribution, gender and baseline characteristics. Pretreatment mean MAP was higher in group 2 as compared to group 1 while decrease in MAP was present in both groups at 24, 36-, 48-, 56- and 60-hours post-treatment; however, this was not statistically significant. 78.9% cases improved with mannitol while 90.5% improved with 3% hypertonic saline but this was not statistically significant. Conclusion Hypertonic saline can be an equally effective agent for management of raised ICP in children but larger and multi-centric study may help in determining which one is better.

A comparison of parental attention and preferred items during tummy time: A consecutive controlled case series evaluation.

Tummy time is an activity for infants to practice their early motor skills. Although most pediatricians recommend tummy time, parents may avoid the procedures due to indices of infant discomfort during this period. This consecutive controlled case series evaluation compared the effects of preferred items selected from a preference assessment with those of parental attention on head evaluation and negative vocalizations during tummy time. In addition, we directly evaluated parental choice by inviting parents to select which tummy time treatment they wanted to implement. We found that both preferred items and parental attention effectively increased head elevation and decreased negative vocalizations during tummy time; however, parents tended to prefer the treatment that included the preferred item.

Evidence and Recommendations for Acute Stroke Rehabilitation from the Japan Stroke Society: Abridged Secondary Publication of the Japanese-language Version.

In Japan, acute stroke rehabilitation has been expanding more steadily than previously with the nationwide establishment of primary stroke centers. However, Japan previously had no established guidelines for the rehabilitation. Consequently, rehabilitation programs and the provision systems for acute stroke varied among the facilities. To equalize and standardize acute stroke rehabilitation in Japan, it is necessary to develop clinical recommendations for rehabilitation. Therefore, the rehabilitation project team of the Japan Stroke Society aimed to develop the first recommendations for acute stroke rehabilitation in Japan. The recommendations are based on the results of a survey on the current status of acute stroke rehabilitation at primary stroke centers in Japan, which was completed in 2022, and on a literature review conducted by the rehabilitation project team. The recommendations consist of 19 clinical questions regarding the following topics of acute stroke rehabilitation: (1) head elevation and mobilization training, (2) acute complications, (3) training time and frequency for acute stroke rehabilitation, (4) dysphagia in the acute phase, and (5) acute rehabilitation during pandemics of novel and re-emerging infections, particularly novel coronavirus disease 2019 (COVID-19). The team members agreed on all answers for these 19 clinical questions. These recommendations suggest broad principles of rehabilitative intervention in the acute phase of stroke. In the near future, it is expected that the dissemination of these recommendations will result in an increase in the quality of acute stroke rehabilitation in Japan.

Effects of Head Elevation on Cerebral Oxygenation in Acute Cerebral Infarction.

This study clarifies the effects of head elevation on cerebral oxygenation in patients with acute cerebral infarction. We included 76 patients with anterior circulation cerebral infarction admitted to the stroke care unit within 7days of symptom onset. Using near-infrared spectroscopy (NIRS), we measured regional saturation oxygen (rSO2), oxygenated haemoglobin (O2Hb), deoxygenated haemoglobin (HHb), and total haemoglobin (THb) in both the affected hemisphere (AH) and unaffected hemisphere (UH) after raising the head to 0°, 30°, and 60° for 1minute each. The mean arterial pressure (MAP) was measured non-invasively at each position. Our result demonstrated a significant decrease in O2Hb as the head elevation angle (HEA) increased, with no observable interaction between the AH and UH. A significant decrease in rSO2 interaction was observed. In contrast, the HHb and THb levels changed significantly as the HEA increased, although no interactions were identified. No significant correlations existed between the observed changes in O2Hb, HHb, THb, or rSO2 and changes in MAP at each HEA.

Evaluation of the Effect of Gluteus Maximus Contraction by Electrical Stimulation on Interfacial Pressure in Supine Bed Positions.

This study investigated the impact of neuromuscular electrical stimulation (NMES) to the gluteus maximus in the bed flat position (F position) and 30-degree head elevation position (30 HE position) on sacral pressure. Twenty volunteers consented to participate in this study. Sacral pressure was measured in the F position and at the 30 HE position with and without NMES in the supine positions. NMES was applied to the gluteus maximus (frequency, 50 Hz; pulse width, 300 μs) with sufficient stimulus intensity to induce muscle contraction. Sacral maximum pressure was determined as peak pressure index (PPI) by averaging the values from the central nine sensors of the maximum pressure zone. The effect of NMES on pressure gradient and the influence of sex difference were also explored. Sacral PPI was significantly lower after NMES implementation in both the F position and the 30 HE position when compared with conditions without NMES (P <0.001). The pressure gradient was also significantly decreased with NMES (P <0.001). Analysis of sex difference in subjects treated with NMES revealed a significantly greater effect on maximum sacral pressure in males than in females. Application of NMES to the gluteus maximus helps to disperse sacral pressure in supine positions. NMES on the gluteus maximus can be a clinical means to manage interfacial pressure in supine positions.

Efficacy of compliance with ventilator-associated pneumonia care bundle: A 24-month longitudinal study at Bach Mai Hospital, Vietnam.

To decrease the risk of complications from ventilator-associated pneumonia, it is essential to implement preventative measures in all ICU patients. Since 2018, with the help of Japanese experts, we have applied a ventilator-associated pneumonia care bundle with 10 basic standards in patient care and monitoring. Therefore, we conducted a study to evaluate the results of applying 10 solutions to prevent ventilator-associated pneumonia over 24 months. A cross-sectional descriptive study with longitudinal follow-up for 24 months on 170 mechanically ventilated patients at the Center for Critical Care Medicine, Bach Mai Hospital. According to the Centers for Disease Control (CDC, 2021), the diagnosis of ventilator-associated pneumonia is when pneumonia appears 48 h after intubation by confirmation by at least two doctors. Evaluate compliance with each solution in the care bundle through camera monitoring, medical records, and directly on patients daily. The rate of ventilator-associated pneumonia is 12.9%, the frequency of occurrence is 16.54 of 1000 days. The compliance rate for complete compliance with a 10-item ventilator-associated pneumonia was only 1.8%, while the average value was 84.1%. Average values of compliance with each solution for hand hygiene, head elevation 30-45 degrees, oral hygiene, stopping sedation, breathing circuit management, cuff pressure management, hypoplastic suction, Spontaneous breathing trial (SBT) daily and assessed extubation, mobilization and early leaving bed, ulcer and thrombosis prevention were 96.9%, 97.3%, 99.4%, 81.5%, 99.9%, 99.9%, 86.3%, 83.5%, 49.3%, and 46.4%, respectively. The time to appear ventilator-associated pneumonia in the high compliance group was 46.7 ± 5.0 days, higher than in the low compliance group, 10.3 ± 0.7 days, p < 0.001. A 10-item ventilator-associated pneumonia care bundle has helped reduce the incidence of ventilator-associated pneumonia. To reduce the risk of ventilator-associated pneumonia and shorten ICU and hospital stays, it is essential to fully adhere to subglottic secretion suction, daily SBT, and early mobilization and leaving the bed.