Neurosurgery Intensive Care Unit Research Articles

Paroxysmal sympathetic hyperexcitability after brain injury: A clinical analysis of case series.

Paroxysmal sympathetic hyperexcitability (PSH) is a group of complex syndromes with various etiologies. Previous studies were limited to the description of traumatic brain injury (TBI), and the description of PSH after other types of brain injury was rare. We explored the clinical features, treatment, and prognosis of PSH after various types of brain injuries. Patients admitted to the neurosurgery intensive care unit with PSH after brain injury from July 2019 to December 2022 were included. Demographic data, clinical manifestations, drug therapy, and disease prognosis were retrospectively collected and analyzed. Fifteen male and 9 female patients with PSH after brain injury were selected. TBI was most likely to cause PSH (66.7%), followed by spontaneous intracerebral hemorrhage (25%). Glasgow coma scale scores of 19 patients (79.2%) were lower than 8 and 14 patients (58.3%) underwent tracheotomy. Electroencephalogram monitoring was performed in 12 individuals, none of which showed epileptic waves. Clinical symptom scale showed mild symptoms in 17 cases (70.8%). Almost all patients were administered a combination of drugs. After follow-up, most patients had a poor prognosis and 2 (8.3%) died after discharge. The etiology of PSH is complex. TBI may be the most common cause of PSH. Non-TBI may also be an important cause of PSH. Therefore, early identification, prevention and diagnosis are helpful for determining the prognosis and outcome of the disease.

A nomogram for predicting the necessity of tracheostomy after severe acute brain injury in patients within the neurosurgery intensive care unit: A retrospective cohort study

ObjectiveThis retrospective study was aimed to develop a predictive model for assessing the necessity of tracheostomy (TT) in patients admitted to the neurosurgery intensive care unit (NSICU). MethodWe analyzed data from 1626 NSICU patients with severe acute brain injury (SABI) who were admitted to the Department of NSICU at the Affiliated People's Hospital of Jiangsu University between January 2021 and December 2022. Data of the patients were retrospectively obtained from the clinical research data platform. The patients were randomly divided into training (70%) and testing (30%) cohorts. The least absolute shrinkage and selection operator (LASSO) regression identified the optimal predictive features. A multivariate logistic regression model was then constructed and represented by a nomogram. The efficacy of the model was evaluated based on discrimination, calibration, and clinical utility. ResultsThe model highlighted six predictive variables, including the duration of NSICU stay, neurosurgery, orotracheal intubation time, Glasgow Coma Scale (GCS) score, systolic pressure, and respiration rate. Receiver operating characteristic (ROC) analysis of the nomogram yielded area under the curve (AUC) values of 0.854 (95% confidence interval [CI]: 0.822–0.886) for the training cohort and 0.865 (95% CI: 0.817–0.913) for the testing cohort, suggesting commendable differential performance. The predictions closely aligned with actual observations in both cohorts. Decision curve analysis demonstrated that the numerical model offered a favorable net clinical benefit. ConclusionWe developed a novel predictive model to identify risk factors for TT in SABI patients within the NSICU. This model holds the potential to assist clinicians in making timely surgical decisions concerning TT.

Safety and efficacy of glibenclamide on cerebral oedema following aneurysmal subarachnoid haemorrhage: a randomised, double-blind, placebo-controlled clinical trial

BackgroundGlibenclamide has garnered attention due to its multifaceted neuroprotective effects in cases of acute central nervous system injury. We initiated a trial to explore the effectiveness and safety of a...

The predictive value of neurally adjusted ventilatory assist indexes for the prognosis of patients with severe cerebral hemorrhage

ObjectiveThis study assessed the predictive value of electrical activity of the diaphragm (EAdi) and the EAdi-derived monitoring index in the prognosis of patients with severe cerebral hemorrhage. MethodsNinety patients with severe cerebral hemorrhage were admitted to the Neurosurgery Intensive Care Unit of Yijishan Hospital from April 2019 to June 2021 and were divided into the good prognosis group (Glasgow Outcome Scale [GOS] ≥ 4) and poor prognosis group (GOS ≤ 3). The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate prediction accuracy.ResultsEAdi, neuro-ventilatory efficiency (NVE), and neuro-muscular efficiency (NME) in patients with good prognosis were significantly higher than those in patients with poor prognosis (4.707 µV vs 2.80 µV, P < 0.001; 141.85 ml/µV vs 66.01 ml/µV, P = 0.000; 2.57 cm H2O/µV vs 1.37 cm H2O/µV, P = 0.000). The area under the ROC curve for the EAdi score was 0.719, with sensitivity of 69.70% and specificity of 68.42% when EAdi was 3.6 µV. The AUC for NVE score was 0.793, with sensitivity of 75.76% and specificity of 75.44% when the NVE value was 95.32 ml/µV. The AUC for NME score was 0.792, with sensitivity of 69.70% and specificity of 78.95% when the NME value was 2.06 H2O/µV. The 6-month survival time of patients with higher EAdi, NVE, and NME was significantly longer than that of patients with lower EAdi, NVE, and NMEConclusionEAdi, NVE, and NME can be used as indices for predicting the prognosis of patients with severe cerebral hemorrhage.Trial registration No.ChiCTR1900022861. Registered April 28, 2019, http://www.chictr.org.cn.

The usefulness of calf circumference in early detection of muscle loss of patients in neurosurgery intensive care unit

The usefulness of calf circumference in early detection of muscle loss of patients in neurosurgery intensive care unit

Conservative Management of Large Vertex Extradural Hematoma: A Case Report

Vertex extradural hematomas may be missed when axial section brain computed tomographic scans are used alone for diagnosis. Conservative treatment may be preferred in such patients when actualized the essential conditions. A 24-year-old mentally retarded male patient was admitted to the emergency department with a history of falling from the same level and head trauma. Neurological examination and axial cross-sectional brain computed tomography performed in the emergency room were evaluated as normal, and the patient was discharged. Vertex extradural hematoma adjacent to the bone fracture was diagnosed with axial, coronal and sagittal reconstructed brain computerized tomography sections of the patient who came back with headache complaint 2 days later. Despite the difficulties in neurological examination due to mental retardation, surgical treatment was not planned with very close neurological examination. The patient was followed up in the neurosurgery intensive care unit for 2 days and in the neurosurgery service for 7 days. He was discharged because there was no abnormality in his neurological follow-ups and no increase in hematoma size. In the first outpatient follow-up, one month later, the hematoma was completely resorbed. The patient was treated conservatively with close conscious and neurological examination follow-up. In order not to miss vertex extradural hematomas in the brain computed tomography performed in patients presenting to the emergency department with head trauma, coronal and sagittal sections should be reconstructed in addition to axial sections. Conservative treatment can be preferred if vertex extradural hematomas are neurological examined closely, no motor deficits and there is no increase in hematoma size in control imaging.

Effects of postoperative lateral positioning on outcomes of patients with subarachnoid hemorrhage

Purpose: This study was conducted to investigate the effects of postoperative lateral positioning on the patients’ outcomes with subarachnoid hemorrhage. &#x0D; Materials and Methods: This study, which is a randomized controlled intervention study, was conducted with 42 (experimental group: 21, control group: 21) patients who underwent subarachnoid hemorrhage surgery in the neurosurgery intensive care unit of a university hospital and met the sampling criteria. In the study, "Patient Descriptive Information Form" and "Patient Results Form" were used as data collection tools. A total of 42 patients operated on for subarachnoid hemorrhage were included in the study. While the patients in the intervention group were placed in the left lateral, right lateral, and semi-fowler position (30 degrees) every 2 to 4 hours for the first 72 hours, those in the control group were routinely placed in the semi-fowler position (20 to 45 degrees). &#x0D; Results: The power of hydrogen value and partial oxygen pressure and arterial oxygen saturation at the 48th hour in the intervention group were statistically significantly higher than the control group at the 72nd hour. In the intervention group, a slight decrease was observed only in the heart rate at 72 hours, which was near normal.&#x0D; Conclusion: Lateral and semi-fowler positions with a 2 to 4 hour interval contributed to improved oxygenation and prevented secondary complications of subarachnoid hemorrhage.

INTENSIVE CARE NURSES' KNOWLEDGE, PRACTICE AND ATTITUDE IN PREVENTION OF CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION (CLABSI)

Central line-associated bloodstream infections (CLABSI) are mainly preventable with evidence-based guidelines. However, it needs to be made clear how well these guidelines are followed in critical care units in Malaysia. Therefore, this study evaluates critical care nurses’ knowledge, practices, and attitude toward evidence-based guidelines for preventing CLABSIs issued by the Centers for Disease Control and Prevention and the Malaysia Ministry of Health. This study aims to identify the level of knowledge, practice, and attitudes regarding preventing CLABSI among critical care nurses in a teaching hospital. A cross-sectional descriptive study was carried out among 203 nurses working in seven units consisting of the Intensive Care Unit (ICU), Coronary Care Unit (CCU), Intermediate Dependency care Unit (IDCU), Neonatal Intensive Care Unit (NICU), Neurosurgery Intensive Care Unit (Neuro ICU), Cardiac Intensive Care Unit (CICU), and Pediatric Intensive Care Unit (PICU) in University Malaya Medical Center in Kuala Lumpur. Nurses completed online questionnaires regarding their demographic characteristics, knowledge, practices, and attitudes toward evidence-based guidelines for preventing CLABSIs from December 2022 to January 2023. The data was analyzed using T-Test, ANOVA, and Fisher’s Exact Test. 203 ICU nurses completed the questionnaire, and none correctly answered all the knowledge-related questions. The response rate of the correct answer regarding the knowledge question was only 49.7%. Mean scores for 11 questions regarding knowledge of evidence-based guidelines for preventing CLABSI were low, 5.85 (± 1.29). Meanwhile, individual total scores were significantly associated with time spent as a nurse in the ICU (2–4 years). The mean score for eight questions related to CLABSI prevention was 4.19 (± 0.50), which was acceptable for the compliance score. There was an association between nurses’ gender (p-value: 0.01) and their duration of working experiences in the ICU (p-value: 0.04) with the practice regarding the prevention of CLABSI. The overall mean score for nurses’ attitudes toward the guidelines was high; 8.63 (± 1.37). However, there was no association between the demographic characteristic and attitude regarding preventing CLABSI. The knowledge and practice of ICU nurses need to be improved. Regular training with the implementation of available guidelines and protocols was essential to improve the knowledge and compliance on preventing CLABSIs in ICUs.

Intra-hospital transfer anxiety of patients in the neurosurgery intensive care unit: A prospective cohort study

BackgroundTransferring a patient from the intensive care unit to different locations within the hospital can cause transfer anxiety. Transfer anxiety is an important factor that adversely affects various physiological and psychological parameters. ObjectiveThe aim of the study is to evaluate the intra-hospital transfer anxiety of patients in a neurosurgery intensive care unit and factors affecting it. MethodsThis prospective cohort study was conducted between November 2021 and June 2022 in a neurosurgery intensive care unit in Istanbul. A total of 171 adult patients who stayed in the intensive care unit for at least 24 h, with a Glasgow Coma Scale score of 14 and above and who had undergone their first intra-hospital transfer were included. Patients’ vital signs were recorded, and their anxiety levels were assessed using the State-Trait Anxiety Inventory. ResultsThe mean age of the patients was 53.16 ± 15.51 years and 56.72% were women, 75.43% of transfers were performed during the day and 64.32% of patients were transferred to an in-patient ward. Factors affecting transfer anxiety were gender, employment status, timing, and purpose of transfer (p < 0.05). Blood pressures and heart rates tended to increase during transfer and decrease again after transfer, while oxygen saturation decreased during transfer (p = 0.035) and increased again after transfer (p < 0.001). State anxiety levels were moderate before transfer and decreased to mild level after transfer (p < 0.001). ConclusionsThe transfer process increased anxiety and caused changes in the vital signs of intensive care patients. Individual and transfer-related factors may influence transfer anxiety. Patients should be monitored for transfer anxiety and nursing interventions to reduce anxiety should be planned. Implications for clinical practiceThe patients’ demographics and transfer details can influence transfer anxiety. Transfer anxiety can affect both subjective parameters and objective measures such as vital signs. Patients at risk of transfer anxiety should be identified before transfers so that nursing interventions to reduce anxiety can therefore be planned.

Beyin ve Sinir Cerrahisi Yoğun Bakım Ünitesinde Beyin Ölümü Tanısı Alan Olguların Retrospektif Olarak Değerlendirilmesi

Introduction: &#x0D; Diagnosis and follow-up of brain death cases in intensive care units are vital in terms of donor and organ transplantation. This study was conducted to retrospectively evaluate the cases diagnosed with brain death in the neurosurgery intensive care unit.&#x0D; Materials and Methods: &#x0D; After the approval of the local ethics committee was obtained, patients who had been diagnosed with brain death between May 2011 and May 2021 in the Neurosurgery Intensive Care Unit of Health Sciences University Izmir Bozyaka Training and Research Hospital were evaluated retrospectively.&#x0D; Results: &#x0D; Of 19 patients diagnosed with brain death, 10 (52.6%) were male, 9 (47.4%) were female, and the mean age was 55.78 (30-74) years. Diagnosis at admission included intracranial hemorrhage (52.6%), traumatic brain injury (36.8%), brain tumor (5.2%), and hydrocephalus (5.2%). Accordingly, diagnostic procedures had been initiated. The diagnosis had been made via an apnea test and neurological examination in 15 of the cases. As the apnea test could not be performed in two cases, additional tests had been performed to support the diagnosis. The rate of cases becoming a donor was 15.7%. &#x0D; Conclusions:&#x0D; In this study, we found that the proportion of patients who had been diagnosed with brain death and had become a donor in the neurosurgery intensive care unit was low. It should be kept in mind that patients with pathologies, such as head trauma, cerebrovascular events, and poor prognosis, may be potential donors and that the necessary examinations and tests for the diagnosis should be initiated without delay.

Development and validation of risk prediction model for refeeding syndrome in neurocritical patients.

The incidence of refeeding syndrome (RFS) in critically ill patients is high, which is detrimental to their prognoses. However, the current status and risk factors for the occurrence of RFS in neurocritical patients remain unclear. Elucidating these aspects may provide a theoretical basis for screening populations at high risk of RFS. A total of 357 patients from January 2021 to May 2022 in a neurosurgery ICU of a tertiary hospital in China were included using convenience sampling. Patients were divided into RFS and non-RFS groups, based on the occurrence of refeeding-associated hypophosphatemia. Risk factors for RFS were determined using univariate and logistic regression analyses, and a risk prediction model for RFS in neurocritical patients was developed. The Hosmer-Lemeshow test was used to determine the goodness of fit of the model, and the receiver operator characteristic curve was used to examine its discriminant validity. The incidence of RFS in neurocritical patients receiving enteral nutrition was 28.57%. Logistic regression analyses showed that history of alcoholism, fasting hours, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, Sequential Organ Failure Assessment (SOFA) scores, low serum albumin, and low baseline serum potassium were risk factors of RFS in neurocritical patients (p < 0.05). The Hosmer-Lemeshow test showed p = 0.616, and the area under the ROC curve was 0.791 (95% confidence interval: 0.745-0.832). The optimal critical value was 0.299, the sensitivity was 74.4%, the specificity was 77.7%, and the Youden index was 0.492. The incidence of RFS in neurocritical patients was high, and the risk factors were diverse. The risk prediction model in this study had good predictive effects and clinical utility, which may provide a reference for assessing and screening for RFS risk in neurocritical patients.

Brain Death and Its Effect on Organ Donation: A 10-Year Analysis

Objective :Brain death can be defined as the irreversible loss of brain functions. It is evident that a delay occurred in the diagnosis of brain death will result in the loss of many cadaveric organs and thus, the number of patients waiting for organ transplantation will increase. Despite there being many studies in the literature about the diagnosis and difficulties of brain death, family interviews, and organ donation, the studies regarding the effects of the regulation change in Turkey on organ donation are limited. The present study includes 10-year retrospective data and it has been conducted to offer an insight to the scientists about the diagnosis of brain death and organ donation.&#x0D; Method: The study was conducted by using data obtained from the examination of the retrospective files of patients diagnosed with brain death between 2011 and 2021 at Pamukkale University, Faculty of Medicine after obtaining the approval of the ethics committee.&#x0D; Results: After the study was initiated, the files of 71 patients diagnosed with brain death between 2011 and 2021, were accessed. Due to the missing information in the files of 4 patients, these patients were excluded from the study. Of 67 patients with registered brain death, 36 were male (53.7%) and 31 were female (46.2%). The age average was 49.07. When the treatment units of these patients were evaluated, 50 patients (74.6%) diagnosed with brain death were treated at the neurosurgery intensive care unit, 7 (10.4%) at the neurology intensive care unit, 6 (9%) at the anesthesia intensive care unit, and 4 (6%) at the cardiovascular surgery intensive care unit.&#x0D; Conclusions:The study concluded that the importance of the diagnosis duration of brain death and the number of specialists who diagnosed brain death in the previous years may have affected this process. It is clear that the formal process, which changed after 2014, showed an acceleration in diagnosis. The importance of the interviews with family members besides the brain death diagnosis has emerged as a result of the study

Effect of neurally adjusted ventilatory assist ventilation in severe neurological cerebrovascular diseases patients undergoing mechanical ventilation

To explore the prognostic effect and safety of neurally adjusted ventilatory assist (NAVA) mode on the patients with severe neurological cerebrovascular disease undergoing mechanical ventilation. A prospective study was conducted. Fifty-four patients with cerebrovascular disease undergoing mechanical ventilation admitted to the neurosurgery intensive care unit (NSICU) of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from December 2020 to May 2022 were enrolled. They were divided into NAVA group and pressure support ventilation (PSV) group by computer random number generator with 27 patients in each group. The ventilation time of the two groups was ≥ 72 hours. The general basic data of the two groups were recorded. The time without mechanical ventilation 28 days after enrollment, total length of mechanical ventilation, survival rate of 90 days after enrollment, length of NSICU stay, total length of hospital stay, NSICU mortality, in-hospital mortality, Glasgow outcome score (GOS), complications related to mechanical ventilation, and changes of respiratory mechanics indexes, arterial blood gases, vital signs, and diaphragm function indexes were observed. The time without mechanical ventilation 28 days after enrollment in the NAVA group was significantly longer than that in the PSV group [days: 22 (15, 26) vs. 6 (0, 23), P < 0.05]. However, there were no significant differences in the total length of mechanical ventilation, 90-day survival rate, length of NSICU stay, total length of hospital stay, NSICU mortality, in-hospital mortality, GOS score, and incidence of mechanical ventilator-related complications between the two groups. In terms of respiratory mechanics parameters, the expiratory tidal volume (VTe) on 3 days after mechanical ventilation of patients in the NAVA group was significantly lower than that on 1 day and 2 days, and significantly lower than that in the PSV group [mL: 411.0 (385.2, 492.6) vs. 489.0 (451.8, 529.4), P < 0.01]. Minute ventilation (MV) at 2 days and 3 days in the NAVA group was significantly higher than that at 1 day, and significantly higher than that in the PSV group at 2 days [L/min: 9.8 (8.4, 10.9) vs. 7.8 (6.5, 9.8), P < 0.01], while there was no significant change of MV in the PSV group. At 1 day, peak airway pressure (Ppeak) and mean airway pressure (Pmean) in the NAVA group were significantly lower than those in the PSV group [Ppeak (cmH2O, 1 cmH2O ≈ 0.098 kPa): 14.0 (12.2, 17.0) vs. 16.6 (15.0, 17.4), Pmean (cmH2O): 7.0 (6.2, 7.9) vs. 8.0 (7.0, 8.2), both P < 0.05]. However, there was no significant difference in the Ppeak or Pmean at 2 days and 3 days between the two groups. In terms of arterial blood gas, there was no significant difference in pH value between the two groups, but with the extension of mechanical ventilation time, the pH value at 3 days of the two groups was significantly higher than that at 1 day. Arterial partial pressure of oxygen (PaO2) at 1 day in the NAVA group was significantly lower than that in the PSV group [mmHg (1 mmHg ≈ 0.133 kPa): 122.01±37.77 vs. 144.10±40.39, P < 0.05], but there was no significant difference in PaO2 at 2 days and 3 days between the two groups. There was no significant difference in arterial partial pressure of carbon dioxide (PaCO2) or oxygenation index (PaO2/FiO2) between the two groups. In terms of vital signs, the respiratory rate (RR) at 1, 2, and 3 days of the NAVA group was significantly higher than that of the PSV group [times/min: 19.2 (16.0, 25.2) vs. 15.0 (14.4, 17.0) at 1 day, 21.4 (16.4, 26.0) vs. 15.8 (14.0, 18.6) at 2 days, 20.6 (17.0, 23.0) vs. 16.7 (15.0, 19.0) at 3 days, all P < 0.01]. In terms of diaphragm function, end-inspiratory diaphragm thickness (DTei) at 3 days in the NAVA group was significantly higher than that in the PSV group [cm: 0.26 (0.22, 0.29) vs. 0.22 (0.19, 0.26), P < 0.05]. There was no significant difference in end-expiratory diaphragm thickness (DTee) between the two groups. The diaphragm thickening fraction (DTF) at 2 days and 3 days in the NAVA group was significantly higher than that in the PSV group [(35.18±12.09)% vs. (26.88±8.33)% at 2 days, (35.54±13.40)% vs. (24.39±9.16)% at 3 days, both P < 0.05]. NAVA mode can be applied in patients with neuro-severe cerebrovascular disease, which can prolong the time without mechanical ventilation support and make patients obtain better lung protective ventilation. At the same time, it has certain advantages in avoiding ventilator-associated diaphragm dysfunction and improving diaphragm function.

ANALYSIS OF READMISSIONS TO NEUROSURGERY INTENSIVE CARE UNIT

Background. Around 10% of patients in developed coun­tries are readmitted to the Intensive care unit during the same hospitalisation each year [1,2]. Readmission is as­sociated with increased length of stay, risk of morbidity and mortality and higher hospital costs [1,3]. Finding out the factors increasing the risk of readmission is es­sential to predict which patients will return to the ICU. Aim. To analyse the incidence and causes of readmissions to the NICU and to assess the impact of readmissions on patients’ outcomes. Methods. A retrospective single-center chart review of 90 patients readmited to the Neurosurgery intensive care unit (NICU) of the Hospital of Lithuanian University of Health Sciences (LUHS) “Kaunas Clinics“ from January 1st to December 31st of 2020, was performed. Demografic and clinical variables such as: admission diagnosis, tim­ing and indications for readmissions, length of NICU stay during readmission, presence of infection, the need for vasopressors and mechanical ventilation (MV) were assessed. Results. 1598 patients were admitted to the NICU in 2020. 90 case histories of readmitted patients were an­alyzed. Patients were divided into survivors and non-survivors groups. 46 (51.50%) of patients were males, the average age was 63.68 (SD 15.89) years. Most fre­quent indications for readmission were respiratory failure (25.56%), reoperation (24.44%), neurological reasons (21.11%, e.g. decreased state of consciousness, status epilepticus). The readmission rate was 5.63%. The mor­tality rate of readmitted patients was 22.50% (the overall mortality in the NICU in 2020 – 10.40%). Presence of nosocomial infection and MV were associated with lon­ger length of stay in the NICU (p &lt; 0.05). Higher mor­tality was related to worse state of consciousness at the time of readmission to the NICU, presence of nosocomial infection, need for vasopressors and/or MV (p &lt; 0.05). Conclusions. The rate of readmission to the NICU was 5.63%. The most common causes for readmission to the NICU were: respiratory failure, reoperation, and neuro­logical indications. The mortality rate of patients that were readmitted to the NICU was higher than overall mortality. Respiratory failure, the need for vasopressors, mechanical ventilation, and hospital-acquired infection were related to worse outcomes.

A study on post intervention impact assessment of antibiotic prescribing practices in the neurosurgery ICU, under antimicrobial stewardship program

Introduction: Antimicrobial Stewardship is a coordinated program that ensures the optimal selection, dose, and duration of an antimicrobial therapy that leads to the best clinical outcome for the treatment or prevention of an infection.Objectives: Objectives of the study are, (1) to describe antibiotic stewardship program implementation by critically evaluating antibiotic prescribing practices; (2) to design an appropriate intervention for subsequent implementation; and (3) to discern the impact of intervention.Methodology: An interventional and cross-sectional study was carried out for 19 months in a neurosurgery intensive care unit (ICU) of a tertiary-care hospital, consisting of three phases: baseline, intervention, and postintervention. First phase involved the evaluation of antibiotic utilization and prescribing practices and appropriateness for the same without provision of any recommendations. In second phase, a 3-component intervention was introduced, i.e. active ICU rounds, postprescription review with feedback and teaching programs. Third phase involved evaluation of antibiotic utilization and prescribing practices and appropriateness for the same with provision of recommendations. The study tool was an antibiotic prescription chart (pre and post-intervention phase) and postprescription review and feedback form (only postintervention phase) that was used for data collection. The primary outcome of the study was days of therapy (DOT) per 1000 In-patient days (PD) for antimicrobials. Data analysis was done by SPSS 23.Results: Overall decrease in the DOT per 1000 In-patient days from baseline to postintervention phase was 17.8% (P = 0.35). The reduction in cost of antibiotic usage per patient day from preintervention phase to postintervention phase was INR 78.1.Conclusion: Antibiotic stewardship ward rounds and dedicated prescription chart can achieve reduction in antibiotic consumption.

A Rare Occurrence of Bilateral Lefort III with a known case of Myocardial Infarction

Background: Patients with LeFort III fractures are at an elevated risk of needing emergency airway management because of midface instability and oropharyngeal airway obstruction. Lefort fracture includes fracture of the nasofrontal junction, bilateral area of the frontozygomatic suture, and probable fracture of the zygomatic arch. This fracture is also referred to as cranial facial disjunction. The Novel treatment for bilateral Lefort III is surgical management and medical management. It may be present in anyone who meets with an accident. Here we present the case of a 41-year adult man who came to the emergency department with complaints of head injury, absence of consciousness, nasal bleed drop by drop, swelling in the face, tooth avulsion, and prickling sensation over the lower right side of the face. The patient was kept in emergency ICU for observation and monitoring for one day, then referred to neurosurgery ICU where he was administered intravenous pan 40mg, Inj emset 2ml, Inj pause 1gm, Inj levopril 1gm, Inj ceftriaxone 1gm, Inj optineurin with 500ml ns, Tab zeredol 20 mg, Tab limce 500mg. The Patient was taken to the ophthalmology operation theater for suturing. Open reduction and internal fixation this surgical procedure is done on my patient. The patient's prognosis was good.

Cognition and practice on transitional care during the transfer from intensive care unit to a general ward among health care professionals: A qualitative study.

The aim of this study is to explore the cognition and practice on transitional care during the transfer from intensive care unit to a general ward among health care professionals in China. Due to the significant differences in the medical and humanistic environment at home and abroad, the safety of patients during the transmission from intensive care unit to the general ward is often ignored when their conditions become stable. There are few qualitative studies on the cognition and practice on transitional care during the transfer from intensive care unit to the ward among health care professionals in China. With a qualitative research design, 20 medical and nursing staff in the neurosurgery intensive care unit and ward were interviewed from May 2021 to August 2021. NVivo 11.0 software was utilized for Colaizzi's (1978) method of data analysis. Based on data analysis, perceptions of transitional care, the influencing factors for transitional care and the recommendations for improving transitional care were obtained. To ensure the continuity of care and improve patient safety during the period from intensive care unit to a general ward in China, we should clarify the expectation for the content of intensive care unit transitional care services, establish the transitional nursing team, guide nursing work, standardize the handover mode and process from intensive care unit to the general ward, promote the communication and coordination of health care professionals and improve the transitional nursing security system from the perspective of institutional level. This study can be used as a guide to help health care professionals provide a reference for the comprehensive development of transitional care services and the formulation of targeted intervention measures during the transfer from intensive care unit to a general ward in China.

Paroxysmal Sympathetic Hyperactivity in Acquired Brain Injury: A Case Series

Background and Aim: Paroxysmal sympathetic hyperactivity (PSH) is a clinical syndrome characterized by paroxysmal and transient episodes of fever, tachypnea, tachycardia, hypertension, diaphoresis, and dystonia following non-noxious stimuli. It is a rare clinical condition and is seen in patients with acquired brain injury (trauma, meningitis, encephalitis, and stroke). Paroxysmal sympathetic hyperactivity-assessment measure (PSH-AM) is a clinical tool for diagnosing PSH. This study aims to describe the clinical characteristics and the outcomes of PSH. Case Presentation: Of the 412 patients admitted to the neurosurgery intensive care unit at PSGIMSR, Coimbatore, India, 11 (2.6%) patients were diagnosed to have PSH according to the PSH-AM scale. Trauma (72%) was the leading cause of the development of PSH. All patients (100%) had developed at least two PSH episodes per day that persisted for at least 3 consecutive days. Tachycardia and tachypnea were the most common symptoms noted in all PSH patients. The Glasgow Outcome Score (GOS) was less than 3 in 72% of PSH cases at the time of discharge, indicating a poor outcome. Conclusion: Traumatic brain injury remained the leading cause of PSH. The duration of hospitalization was increased in patients with PSH. Along with the prompt treatment of the primary disease, appropriate medications to overcome sympathetic hyperactivity ensure better recovery for these patients. Patients with PSH had relatively poor GOS at the time of discharge.

Moyamoya Disease

Abstract Moyamoya disease is a rare disease that causes progressive narrowing of the intracranial internal carotid arteries, resulting in reduced blood supply to the brain, leading to strokes. It is a major cause of childhood stroke. A 10-year-old boy presented with recurrent left-hemispheric transient ischemic attack and seizures. On evaluation, the child was diagnosed as having bilateral moyamoya disease. The child was prescribed antiplatelets and antiepileptics and advised to drink 2 liters of water a day and to avoid dehydration. He was admitted for an elective revascularization surgery. Left-side superficial temporal artery to middle cerebral artery bypass with encephaloduroarteriomyosynangiosis was done. The child was monitored in the postoperative neurosurgery intensive care unit for 1 day for any postprocedure complications. Postoperative course was uneventful, and the child was discharged on the sixth postoperative day with instruction to continue antiplatelets and antiseizure medications. The outcome of cerebral revascularization in moyamoya disease is good, with reduction in ischemic events and seizures. Postoperative nursing care in neurosurgery units is important in preventing complications and achieving better outcomes.

Designing predictive models for appraisal of outcome of neurosurgery patients using machine learning-based techniques

BackgroundRecently, machine learning (ML) methods have been progressively applied in medical researches. Predicting ICU outcome helps hospitals to better manage their resources. In addition, by recognition of the most important factors in predicting ICU outcome, some new protocols may be developed to consider these factors in the treatment. ObjectiveThe present study is a descriptive applied study in the field of ML and intensive care unit (ICU) to determine the predicting factors associated with the outcome of neurosurgery ICU. MethodData of 1200 patients admitted to the neurosurgery ICU, [BLINDED FOR REVIEW] during the period of 2017 to 2019 was studied. Demographic features (age, sex, weight, height), comorbidities, ICU admission time, ICU re-admission, smoking and related complications were collected. Neighborhood Component Analysis (NCA) was used as a non-parametric strategy for choosing features with the aim of enhancing prediction accuracy of regression and classification algorithms. ResultsUsing this approach, we found that the most important predictor factors for the outcome of neurosurgery patients were age, weight, hypertension, diabetes insipidus, diabetes mellitus, prior operation, smoking and alcohol, sex, blood glucose, ischemic heart disorder, meningitis, acute kidney injury, tracheostomy, prior ICU admission, seizure, and fever. ConclusionThe application of ML enables the prediction of outcomes of neurosurgery patients.