Neuroscience Intensive Care Unit Research Articles

Increasing the Volume of Delivered Enteral Feeds Using a Volume-Based Feeding Protocol in a Neuroscience Intensive Care Unit.

Iatrogenic malnutrition is a significant burden to patients, clinicians, and health care systems. Compared with well-nourished patients, underfed patients (those who receive less than 80% of their daily energy requirement) have more adverse outcomes related to nutritional status. Volume-based protocols allow for catch-up titrations, are consistently superior to rate-based protocols, and can be implemented in most settings. This project was conducted in an 8-bed neuroscience intensive care unit in which up to 41% of patients who required enteral feeding were underfed. This quality improvement clinical practice change project used a before-and-after design to evaluate (1) the effect of implementing a volume-based feeding protocol on the delivery of enteral feeds and (2) the effect of a nutrition-based project on staff members' attitudes regarding nutrition in critical care. The effectiveness of a volume-based feeding titration protocol was compared with that of a rate-based feeding protocol for achieving delivery of at least 80% of prescribed nutrition per 24-hour period. Staff members' attitudes were assessed using a survey before and after the project. During 241 enteral feeding days (n = 40 patients), the percentage of delivered enteral feeding volume and the percentage of days patients received at least 80% of the prescribed volume increased after volume-based feeding was implemented. After project implementation, 74 staff members reported increased emphasis on nutrition delivery in their practice and a higher level of agreement that nutrition is a priority when caring for critically ill patients. Using a volume-based feeding protocol with supplemental staff education resulted in improved delivery of prescribed enteral feeding.

The Feasibility of a Brain Care Self-assessment Tool in the Neurosciences Intensive Care Unit (P11-2.003)

The Feasibility of a Brain Care Self-assessment Tool in the Neurosciences Intensive Care Unit (P11-2.003)

Acute Encephalopathy in the Neurosciences Intensive Care Unit: Etiologies and Exploratory Descriptive Analysis of Outcome, Length of Stay, and EEG Data (S23.002)

Acute Encephalopathy in the Neurosciences Intensive Care Unit: Etiologies and Exploratory Descriptive Analysis of Outcome, Length of Stay, and EEG Data (S23.002)

The Impact of Fluid Balance on Acute Kidney Injury in Nontraumatic Subarachnoid Hemorrhage.

Background: Nontraumatic subarachnoid hemorrhage (SAH) can lead to poor neurologic outcomes, particularly when delayed cerebral ischemia (DCI) occurs. Maintenance of euvolemia following SAH is thought to reduce the risk of DCI. However, attempts at maintaining euvolemia often err on the side of hypervolemia. In this study, we assessed the relationship between fluid balance and acute kidney injury (AKI) in SAH patients, assessing hypervolemia versus euvolemia and their impact on AKI. Methods: In a quaternary care center, neuroscience intensive care unit we conducted a retrospective longitudinal analysis in adult patients who suffered a nontraumatic SAH. Results: Out of 139 patients, 15 (10.8%) patients developed an AKI while hospitalized, with 7 stage I, 3 stage II, and 5 stage III injuries. Acute kidney injury patients had higher peak sodium (150.1 mEq/L vs 142.7 mEq/L, 95% confidence interval [CI]: [2.7-12.1 mEq/L]), higher discharge chloride (109.1 mEq/L vs 104.9 mEq/L, 95% CI: [0.7-7.6 mEq/L]), and lower hemoglobin at discharge (9.3 g/dL vs 11.3 g/dL, 95% CI: [1.0-2.9 g/dL]). At 7 days, AKI patients had a fluid balance that was 1.82 L higher (P = .04), and 3.38 L higher at 14 days (P = .02), in comparison to day 3. Acute kidney injury was associated with significant mortality increases. This increase in mortality was found at 30 days from admission with a 9.52-fold increase, and at 60 days with a 6.25-fold increase. As a secondary outcome, vasospasm (19 patients, 13.7%) showed no association with AKI. Conclusions: Acute kidney injury following SAH is correlated with clinically significant hypervolemia, elevated sodium, elevated chloride, decreased urine output, and decreased hemoglobin at discharge-risk factors for all SAH patients. This study further elucidates the harm of hypervolemia and gives greater practical evidence to physicians attempting to balance the dangers of vasospasm and AKI.

Consistently Exploring Nurse Staffing and Neurocritical Care Unit Turnover.

BACKGROUND: Staffing models within nursing units have long been a hot topic of discussion. The COVID-19 pandemic exacerbated this discussion by straining the national nursing environment and workforce. Before the pandemic, the neuroscience intensive care unit (NSICU) primarily used an acuity-adjusted staffing model and aimed for a nurse-to-patient ratio of 1:1.5. During and after the pandemic, the NSICU was forced to primarily use a centralized staffing model because of the increased turnover in the hospital at large and a rise in patient census. METHODS : Unit census data in an NSICU were tracked before, during, and after the pandemic alongside utilization of a centralized staffing model in the hospital at large. RESULTS : During this time, the NSICU saw a statistically significant increase in average nurse-to-patient ratio and incidences of both floating and tripled assignments. The NSICU simultaneously saw a 180% increase in nursing turnover. CONCLUSION : Although we cannot prove that a centralized staffing model is directly responsible for higher nursing turnover, its utilization led to greater incidence of poor staffing-reflected in deviation from the nurse-to-patient ratio goal of the unit. Nurse staffing concerns play a large role in nurse satisfaction in the workforce: staffing shortages have been described both as a precursor to and as a consequence of increased nursing turnover.

Mesenchymal Stem Cell Therapy in Acute Intracerebral Hemorrhage: A Dose-Escalation Safety and Tolerability Trial.

We conducted a preliminary phase I, dose-escalating, safety, and tolerability trial in the population of patients with acute intracerebral hemorrhage (ICH) by using human allogeneic bone marrow-derived mesenchymal stem/stromal cells. Eligibility criteria included nontraumatic supratentorial hematoma less than 60mL and Glasgow Coma Scale score greater than 5. All patients were monitored in the neurosciences intensive care unit for safety and tolerability of mesenchymal stem/stromal cell infusion and adverse events. We also explored the use of cytokines as biomarkers to assess responsiveness to the cell therapy. We screened 140 patients, enrolling 9 who met eligibility criteria into three dose groups: 0.5 million cells/kg, 1 million cells/kg, and 2 million cells/kg. Intravenous administration of allogeneic bone marrow-derived mesenchymal stem/stromal cells to treat patients with acute ICH is feasible and safe. Future larger randomized, placebo-controlled ICH studies are necessary to validate this study and establish the effectiveness of this therapeutic approach in the treatment of patients with ICH.

Implementation of an early mobility protocol in the neuroscience ICU

Abstract 
 Background: Early mobility is a safe and effective intervention to improve patient outcomes in the neuroscience intensive care unit (ICU). However, mobilization of patients in a neuroscience ICU within an academic medical center was suboptimal, with less than 36% of patients achieving their highest level of mobility.
 Aim: The purpose of the quality improvement project was to develop and implement a multidisciplinary early mobility protocol, including a safety-screening tool.
 Methods: Iterative Plan-Do-Study-Act cycles were implemented from April to August 2022. The screening tool assisted nurses in assessing the patient’s eligibility for early mobilization. A mobility section addressing patient-specific mobility screening, barriers to mobility, and a daily mobility plan was added to the provider note templates. Baseline data were collected from September to November 2021; post-implementation data were collected from April to August 2022.
 Results: There was a reduction in the mean time between admission to the first documented out of bed activity from 3.24 to 2.01 days, p=.061. The mean number of documented out of bed activities significantly increased from 6.13 to 8.35, p = .002. Hospital length of stay significantly decreased from 19.8 to 12.42 days, p=.006.
 Conclusions: Implementing an early mobility screening tool and protocol in the neuroscience ICU increased mobility for patients with neurological diagnoses. Other hospitals should consider implementing a similar process to help improve patient outcomes.

Catheter-associated urinary tract infection (CAUTI) reduction in a neuroscience intensive care unit: A multidisciplinary approach

Utilizing a multidisciplinary approach to identify catheter-associated urinary tract infection (CAUTI) risks in Neuroscience intensive care patients admitted for aneurysmal subarachnoid hemorrhage, our CAUTI rate decreased from 5.903 per 1,000 catheter days (June 2020-June 2021) to 0.371 per 1,000 catheter days in our postintervention time period (July 2021-March 2023). A review of our clinical treatment guideline to optimize the timing of indwelling urinary catheters and medication management related to bowel regimens has resulted in a sustained CAUTI reduction, particularly in postaneurysmal subarachnoid hemorrhage patients in the Neuroscience intensive care unit.

Safety and Feasibility of a Fast-Track Pathway for Neurosurgical Craniotomy Patients: Bypassing the Intensive Care Unit

To describe the safety and feasibility of a fast-track pathway for neurosurgical craniotomy patients receiving care in a neurosciences progressive care unit (NPCU). Traditionally, most craniotomy patients are admitted to the neurosciences intensive care unit (NSICU) for postoperative follow-up. Decreased availability of NSICU beds during the coronavirus disease-2019 delta surge led our team to establish a de-novo NPCU to preserve capacity for patients requiring high level of care and would bypass routine NSICU admissions. Patients were selected a priori by treating neurosurgeons on the basis of the potential need for high-level ICU services. After operation, selected patients were transferred to the postoperative care unit, where suitability for NPCU transfer was reassessed with checklist-criteria. This process was continued after the delta surge. From July 1, 2021 to September 30, 2022, 57 patients followed the NPCU protocol. Thirty-four (59.6%) were women, and the mean age was 56 years. Fifty-seven craniotomies for 34 intra-axial and 23 extra-axial lesions were performed. After assessment and application of the checklist-criteria, 55 (96.5%) were transferred to NPCU, and only 2 (3.5%) were transferred to ICU. All 55 patients followed in NPCU had good safety outcomes without requiring NSICU transfer. This saved $143,000 and led to 55 additional ICU beds for emergent admissions. This fast-track craniotomy protocol provides early experience that a surgeon-selected group of patients may be suitably monitored outside the traditional NSICU. This system has the potential to reduce overall health care expenses, increase capacity for NSICU bed availability, and change the paradigm of NSICU admission.

Headache Management in the Neuroscience Intensive Care Unit.

Headache is a common symptom in the Neuroscience Intensive Care Unit (NeuroICU). Our goal is to provide an overview of approaches to headache management for common neurocritical care conditions. Headache disorders afflict nearly half of patients admitted to the NICU. Commonly encountered disorders featuring headache include cerebrovascular disease, trauma, and intracranial infection. Approaches to pain are highly variable, and multimodal pain regimens are commonly employed. The overall body of evidence supporting therapeutic strategies to manage headache in the critical care setting is slim, and pain control remains suboptimal in many cases with persistent reliance on opioids. Headache is a complex, frequently occurring phenomenon in the NeuroICU care setting. At present, literature on evidence-based practice for management of headache in the critical care setting remains scarce, and despite multimodal approaches, reliance on opioids is commonplace.

Shock Severity Classification and Mortality in Adults With Cardiac, Medical, Surgical, and Neurological Critical Illness

ObjectiveTo evaluate whether the Society for Cardiovascular Angiography and Interventions (SCAI) Shock Classification could perform risk stratification in a mixed cohort of intensive care unit (ICU) patients, similar to its validation in patients with acute cardiac disease. MethodsWe included 21,461 adult Mayo Clinic ICU patient admissions from December 1, 2014, to February 28, 2018, including cardiac ICU (16.7%), medical ICU (37.4%), neurosciences ICU (27.7%), and surgical ICU (18.2%). The SCAI Shock Classification (a 5-stage classification from no shock [A] to refractory shock [E]) was assigned in each 4-hour period during the first 24 hours of ICU admission. ResultsThe median age was 65 years, and 43.2% were female. In-hospital mortality occurred in 1611 (7.5%) patients, with a stepwise increase in in-hospital mortality in each higher maximum SCAI Shock stage overall: A, 4.0%; B, 4.6%; C, 7.0%; D, 13.9%; and E, 40.2%. The SCAI Shock Classification provided incremental mortality risk stratification in each ICU, with the best performance in the cardiac ICU and the worse performance in the neurosciences ICU. The SCAI Shock Classification was associated with higher adjusted in-hospital mortality (adjusted odds ratio, 1.32 per each stage; 95% CI, 1.24 to 1.41; P<.001); this association was not observed in the neurosciences ICU when considered separately. ConclusionThe SCAI Shock Classification provided incremental mortality risk stratification beyond established prognostic markers across the spectrum of medical and surgical critical illness, proving utility outside its original intent.

Thematic Analysis of Psychosocial Stressors and Adaptive Coping Strategies Among Informal Caregivers of Patients Surviving ICU Admission for Coma.

Family caregivers of patients with severe acute brain injury (SABI) admitted to intensive care units (ICUs) with coma experience heightened emotional distress stemming from simultaneous stressors. Stress and coping frameworks can inform psychosocial intervention development by elucidating common challenges and ways of navigating such experiences but have yet to be employed with this population. The present study therefore sought to use a stress and coping framework to characterize the stressors and coping behaviors of family caregivers of patients with SABI hospitalized in ICUs and recovering after coma. Our qualitative study recruited a convenience sample from 14 US neuroscience ICUs. Participants were family caregivers of patients who were admitted with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, traumatic brain injury, or hypoxic-ischemic encephalopathy; had experienced a comatose state for > 24h; and completed or were scheduled for tracheostomy and/or gastrostomy tube placement. Participants were recruited < 7days after transfer out of the neuroscience ICU. We conducted live online video interviews from May 2021 to January 2022. One semistructured interview per participant was recorded and subsequently transcribed. Recruitment was stopped when thematic saturation was reached. We deductively derived two domains using a stress and coping framework to guide thematic analysis. Within each domain, we inductively derived themes to comprehensively characterize caregivers' experiences. We interviewed 30 caregivers. We identified 18 themes within the two theory-driven domains, including ten themes describing practical, social, and emotional stressors experienced by caregivers and eight themes describing the psychological and behavioral coping strategies that caregivers attempted to enact. Nearly all caregivers described using avoidance or distraction as an initial coping strategy to manage overwhelming emotions. Caregivers also expressed awareness of more adaptive strategies (e.g., cultivation of positive emotions, acceptance, self-education, and soliciting social and medical support) but had challenges employing them because of their heightened emotional distress. In response to substantial stressors, family caregivers of patients with SABI attempted to enact various psychological and behavioral coping strategies. They described avoidance and distraction as less helpful than other coping strategies but had difficulty engaging in alternative strategies because of their emotional distress. These findings can directly inform the development of additional resources to mitigate the long-term impact of acute psychological distress among this caregiver population.

Multidisciplinary Approach to Sedation and Early Mobility of Intubated Critically Ill Neurologic Patients Improves Mobility at Discharge.

Over-sedation may confound neurologic assessment in critically ill neurologic patients and prolong duration of mechanical ventilation (MV). Decreased sedative use may facilitate early functional independence when combined with early mobility. The objective of this study was to evaluate the impact of a stepwise, multidisciplinary analgesia-first sedation pathway and early mobility protocol on medication use and mobility in the neuroscience intensive care unit (ICU). We performed a single-center prospective cohort study with adult patients admitted to a neuroscience ICU between March and June 2016-2018 who required MV for greater than 48 hours. Patients were included from three separate phases of the study: Phase I - historical controls (2016); Phase II - analgesia-first pathway (2017); Phase III - early mobility protocol (2018). Primary outcomes included propofol requirements during MV, total rehabilitation therapy provided, and functional mobility during ICU admission. 156 patients were included in the analysis. Decreasing propofol exposure was observed during Phase I, II, and III (median 2243.7 mg/day vs 2065.6 mg/day vs 1360.8 mg/day, respectively; P = .04 between Phase I and III). Early mobility was provided in 59.7%, 40%, and 81.6% of patients while admitted to the ICU in Phase I, II, and III, respectively (P < .01). An increased proportion of patients in Phase III were walking or ambulating at ICU discharge (26.7%; 8/30) compared to Phase I (7.9%, 3/38, P = .05). An interdisciplinary approach with an analgesia-first sedation pathway with early mobility protocol was associated with less sedative use, increased rehabilitation therapy, and improved functional mobility status at ICU discharge.

Opportunities and Barriers in the Planning of Hospital Bed Capacity in a Tertiary Care Hospital in Makkah, Saudi Arabia

Introduction: In alignment with Saudi Arabia’s 2030 Vision to improve healthcare services, Saudi hospital policymakers must have a clear understanding of the needs of their hospitals to make strategic decisions regarding hospital bed capacity planning. King Abdullah Medical City (KAMC) is a tertiary and quaternary healthcare facility that has four state-of-the-art excellence centers, of which the Cardiac and Oncology Centers are among the largest and the most advanced in the west of Saudi Arabia. Methods: This study used a mixed-methods approach. The study’s quantitative component included a revision of retrospective data of KAMC’s operational parameters, such as bed capacity, bed occupancy rate (BOR), and length of stay (LOS). For the study’s qualitative component, researchers used semi-structured interviews. Personnel at different management levels were interviewed to explore factors that might influence an increase in the BOR and patients’ LOS. Results: KAMC’s key performance indicators showed an overall LOS of 9.9 days and an overall BOR of 88%. Analysis broken down by the department shows the General and the Neuroscience Intensive Care Units and the Hematology/Oncology departments to have the highest BOR, ranging between 95% and 97%. Qualitative analysis of semi-structured interviews suggested that the delays in the provision of consultation services among the hospital’s inpatients were among the factors that have the biggest influence on bed occupancy; the presence of dedicated case managers in every department was among the top suggested solutions. Conclusion: A battery of interventions might help to reduce the LOS by supporting timely patient discharge. The presence of a dedicated case manager with a medical background in each department is one of the most practical interventions. Other vital opportunities include reinforcement of back-referral policies, revising policies, and having cluster-level referral policies and bed management strategies. Although such efforts are likely to have a positive effect, they are expected to only partially meet the existing gap, which probably requires increasing the number of available active beds.

Case 313: Cerebral Venous Infarct Due to Internal Cerebral Vein Thrombosis in the Setting of COVID-19 Infection

A 45-year-old woman presented to the emergency department of an outside hospital with shortness of breath and cough. Five days after initial presentation, the patient presented again to the same emergency department with worsening headache and progressive left arm and left leg weakness. She was transferred to the neuroscience intensive care unit of our hospital with concern for an intracranial abnormality based on her work-up at the outside hospital. Her past medical history was notable only for a large uterine fibroid. In our hospital, CT of the brain and chest and MRI of the brain, including perfusion studies, were performed. Additionally, CT venography of the brain was performed.

Quantitative Pupillometry is Not Impacted By IV Opioid or Sedative Bolus Dosing (P11-7.005)

<h3>Objective:</h3> Evaluate effect of intermittent intravenous opioids and sedatives on Neurological Pupil Index (NPi) using Quantitative Pupillometry (QP). <h3>Background:</h3> Opioids and sedatives are widely used in the Neuroscience ICU (NSICU). NPi, an objective measurement of pupillary light reflex (PLR), is a critical component of the neurologic examination and is measured routinely using QP. Yet whether NPi values are affected by opioid or sedative bolus in acutely ill patients is unknown. <h3>Design/Methods:</h3> Prospective, observational, pragmatic study of adult patients (≥18 years old) admitted to the NSICU with any admission diagnosis who received bolus doses of IV opioids or sedatives. 100 patients will be enrolled for final analysis. NPi was assessed using the NPi-300 pupillometer within 30 minutes prior to and 15 minutes after administration of IV opioid or sedative administration. Opioids and sedatives utilized include hydromorphone, fentanyl, morphine, and midazolam. Descriptive data were obtained for demographics. Paired t-test was used to compare pre and post NPi values. <h3>Results:</h3> 39 patients were included in the interim analysis: 54% female, median age 48 (IQR 39–65). Of 39 patients, 35 (90%) received hydromorphone, 2 (5%) received morphine, 1 (2.5%) received fentanyl, and 1 (2.5%) received midazolam. Mean premedication NPi of the RIGHT eye was 4.25 (0.47), and mean premedication NPi of the LEFT eye was 4.27 (0.47). Mean post-medication NPi of the RIGHT eye was 4.26 (0.47), <i>P</i>=0.73. Mean post-medication NPi of the LEFT eye was 4.27 (0.46), <i>P</i>=0.99. Numbers in parenthesis represent standard deviation unless otherwise noted. <h3>Conclusions:</h3> NPi does not significantly differ from before to after administration of bolus IV opioids or sedatives. Significant changes in NPi are unlikely to be related to medication administration and should be correlated clinically. <b>Disclosure:</b> Dr. Battley has nothing to disclose. Ms. Marshall has nothing to disclose. DaiWai Olson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Minnetronix. The institution of DaiWai Olson has received research support from Neuroptics. The institution of DaiWai Olson has received research support from Ceribell. Sonja Stutzman, 10738 has received publishing royalties from a publication relating to health care. Dr. Reyes has nothing to disclose.

Concordance Between Active Partial Thromboplastin Time and Anti-Factor Xa Assays in Neurocritically Ill Patients Receiving Subcutaneous Heparin Prophylaxis.

Laboratory monitoring is not recommended when subcutaneous unfractionated heparin (SQ-UFH) is administered at prophylactic doses. However, aPTT prolongation and associated hemorrhage has been reported in the neurocritically ill. At our institution, Neuroscience Intensive Care Unit (Neuro-ICU) patients with prolonged aPTT are further evaluated with a follow up aPTT and anti-factor Xa. The purpose of this study was to describe concordance between aPTT and anti-factor Xa in neurocritically ill patients receiving prophylactic SQ-UFH with evidence of aPTT prolongation. A retrospective chart review of adult patients admitted to the Neuro-ICU from June 2017 to June 2019 was performed. Patients were included if they received SQ-UFH with aPTT levels and at least one anti-factor Xa level drawn within one hour of each other. Concordance between paired aPTT and anti-factor Xa was evaluated using Cohen's weighted kappa. Forty two patients with 56 paired aPTT and anti-factor Xa levels were included. The most prescribed SQ-UFH regimen was 5000 units every 8 hours (60.7%) and anti-factor Xa levels were drawn a median (IQR) of 5.7 (3.1-10.7) hours after the SQ-UFH dose. Only 16 (28.6%) pairs were in concordance. The analysis showed a weighted kappa of .09; 95% CI [-.05 to .22] indicating poor agreement. In neurocritically ill patients receiving prophylactic SQ-UFH with aPTT prolongation, there was poor concordance between aPTT and anti-factor Xa. This suggests that aPTT prolongation may not be solely driven by heparin activity and further evaluation of mechanistic drivers for coagulopathy in this population is necessary.

Quantitative Pupillometry Values are Remarkably Similar Before and After Neuroimaging

BackgroundAutomated assessment of the pupillary light reflex (PLR) is becoming more mainstream, yet there is much to learn about the correlations between automated PLR metrics and standard practice. This study explores the feasibility and potential value of assessing PLR using quantitative pupillometry (QP) in patients with critical neurologic illness before and after neuroimaging. MethodsPLR assessments using QP were taken within 30 minutes before and 30 minutes after computerized tomography (CT) or magnetic resonance imaging (MRI) on patients in the neuroscience intensive care unit. ResultsFifty patients were enrolled. The neurological pupil index (NPi®) was 3.98 (1.12) in the right eye and 3.96 (1.0) in the left eye before imaging, and 4.13 (1.08) in the right eye and 4.08 (0.93) in the left eye after imaging. Although the before and after difference in the left eye was a statistically significant (p < .01), these differences were not clinically relevant. Roughly 8% of subjects showed improvement in NPi scores from abnormal (<3.0) before imaging, to normal (>3.0) after. ConclusionObtaining QP readings before and after neuroimaging is feasible and safe. Yet, these data suggest it may not be necessary to obtain pre-QP and post-QP readings when the NPi is normal before CT or MRI.

Does gender moderate resiliency variables and posttraumatic stress symptoms in informal caregivers of neurocritical care patients? An exploratory study

ABSTRACT We examined gender differences between resiliency factors (i.e. mindfulness, self-efficacy, coping, intimate care, and caregiver preparedness) and posttraumatic stress symptoms (PTSS) in informal caregivers of patients in the neuroscience intensive care unit (Neuro-ICU). Ninety-two informal caregivers were enrolled during patients’ hospitalization and completed resiliency measures at baseline, and a PTSS measure at baseline, 3 and 6 months. We conducted five ANCOVAs to explore gender and resiliency on PTSS. No significant main effects of gender on PTSS were observed across time points. However, main effects were seen for resiliency on PTSS at baseline for informal caregivers with high (vs. low) mindfulness, coping, and self-efficacy. Gender moderated the association between mindfulness and PTSS (i.e. high mindfulness at baseline was associated with lower PTSS in males compared to females at 3 months) and intimate care and PTSS (high intimate care at baseline was associated with lower PTSS in males than females at 6 months; high intimate care at baseline for females was associated with lower PTSS at 6 months than females with low intimate care). Overall, we observed associations among informal caregivers’ gender, resiliency, and PTSS, with males particularly benefitting from mindfulness and intimate care. These findings hold value for future inquiry into gender differences in this population with possible clinical implications.

The Impact of Embedding a Palliative Care Advance Practice Provider on a Neuroscience Intensive Care Unit Service

Palliative care is a service that works together with the patient’s primary team in an inpatient setting to provide additional guidance, support, and symptom management to patients dealing with a serious illness. Neuroscience intensive care unit patients are both complex and acute and often require multiple collaborating services to provide efficient and proper care. A palliative care nurse practitioner was embedded on the neuroscience ICU team; in doing so, the number of consults, family meetings, and follow-up visits increased. Multidisciplinary staff members had a better understanding of the role of palliative care. There were many benefits from the addition of a palliative care nurse practitioner.