Evidence-Based Nursing Review of Craniectomy Care

Livesay, Sarah; Moser, Hope

doi:10.1161/strokeaha.114.006355

Cited by 13 publications

(9 citation statements)

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“…This is partly because adverse outcomes due to falls after hemicraniectomy are very rare. Some experts suggest use of a helmet in such circumstances (20), but this is not universal and practises vary between different centres and between different countries. Rather than seeking evidence for the efficacy of helmets in the setting of post-operative malignant middle cerebral artery patient, we adopt a novel approach.…”

Section: Discussionmentioning

confidence: 99%

Physiotherapist confidence level in mobilising stroke patients after decompressive hemicraniectomy: are helmets useful?

Budhdeo

Meek

Cosco

et al. 2019

Preprint

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IntroductionDecompressive hemicraniectomy is a lifesaving measure in malignant middle cerebral artery infarction; however, this leaves patients with a skull defect. There is variability of helmet use in this patient group across Britain. We aimed to examine whether (1) specialist physiotherapist were more confident mobilising a patient with hemiparesis and skull defect than a non-specialist physiotherapist (2) non-specialist and specialist physiotherapists would be more comfortable mobilising this patient with a helmet as opposed to without a helmet.MethodsWe carried out a cross-sectional online survey of specialist physiotherapists and non-specialist physiotherapists in Britain. Recruitment was through mailing lists. Physiotherapists were asked to rank their confidence level on a 5-point Likert scale of mobilising an example patient with and without a helmet. They were also asked about the number of additional therapists needed to safely mobilise the patient.Findings96 physiotherapists completed the survey; 44 were specialists and 52 were non-specialists. Specialist physiotherapists felt more comfortable mobilising patients (mean difference = 0.68, p < 0.001). Non-specialist physiotherapists felt significantly more comfortable mobilising patients with a helmet (mean difference = 0.96, p value < 0.001), as did specialist physiotherapists (mean difference = 0.68, p value < 0.001). There was no difference in confidence level arising from helmet use between the two groups (p = 0.72).ConclusionsUse of helmets may allow specialist and non-specialist physiotherapists to feel more comfortable when mobilising stroke patients post-decompressive hemicraniectomy. Consideration should be made by hospitals and health systems for the provision of helmets this patient group, to maximise functional gains.

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Section: Discussionmentioning

confidence: 99%

Physiotherapist confidence level in mobilising stroke patients after decompressive hemicraniectomy: are helmets useful?

Budhdeo

Meek

Cosco

et al. 2019

Preprint

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“…1 First, we applaud the authors for this excellent summary of nursing care and for the table of nursing monitoring and discussion of other concerns regarding patients with decompressive craniectomy. The summary they provide is useful, and we hope to educate our nurses in our NeuroICU with this reference.…”

Section: To the Editormentioning

confidence: 99%

Letter by Freeman et al Regarding Article, “Evidence-Based Nursing Review of Craniectomy Care”

Freeman

Smith

Brown

2015

Stroke

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We read with great interest the article by Livesay et al entitled "Evidence-Based Nursing Review of Craniectomy Care."1 First, we applaud the authors for this excellent summary of nursing care and for the table of nursing monitoring and discussion of other concerns regarding patients with decompressive craniectomy. The summary they provide is useful, and we hope to educate our nurses in our NeuroICU with this reference. We find the figure especially nice and concise for our nursing education, and we appreciated the Take Home Points and the attention to the largely unstudied nature of many nursing and allied health aspects of these patients, such as use of helmets. We wanted to mention 2 minor points. The first was an observation in our own NeuroICU that we feel is important in the daily nursing management in decompressive craniectomy patients-the use of train of four (TOF) nerve stimulators in critically ill neuroICU patients who require neuromuscular paralysis, such as cis-atricurium and the use of prolonged TOF monitoring.2 Sometimes limb edema can limit the TOF response at the median or ulnar nerves, and occasionally, we have seen nursing perform TOF at or around the eye in attempts to do peripheral cranial nerve VII stimulation and for orbicularis oculi TOF response.3-5 However, TOF stimulation in decompressive craniectomy patients should not be performed over the decompressive craniectomy side if unilateral (such as a large decompessive hemicraniectomy) or either side if bifrontal. We feel it is important to consider adding to the list of issues in these subspecialty neuroICU patients who are perhaps under neuromuscular monitoring. The second point concerns underwound monitoring; we also ask our nursing staff to look out for acute turgor or girth of the craniectomy site because of concerns of acute surgical bleeding, but also for cerebrospinal fluid leakage. Overall, we commend the authors' excellent review on this subject and think it adds greatly to the literature and can improve the nursing care of these patients. DisclosuresNone.

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“…Decompressive craniectomy remains a mainstay of treatment for patients with refractory elevated intracranial pressure, including patients with intracerebral haemorrhage and malignant stroke. Patients are typically advised to wear helmets after the craniectomy to avoid injury to the unprotected brain when mobilising ( 1 ). In contrast, the utility of head protection in supine or semi-recumbent positions at rest is unclear.…”

Section: Introductionmentioning

confidence: 99%

The Need for Head Protection Protocols for Craniectomy Patients during Rest, Transfers and Turning

Pandit

Singhal²,

Khawari

et al. 2022

Front. Surg.

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After craniectomy, patients are generally advised to wear a helmet when mobilising to protect the unshielded brain from damage. However, there exists limited guidance regarding head protection for patients at rest and when being transferred or turned. Here, we emphasise the need for such protocols and utilise evidence from several sources to affirm our viewpoint. A literature search was first performed using MEDLINE and EMBASE, looking for published material relating to head protection for patients post-craniectomy during rest, transfer or turning. No articles were identified using a wide-ranging search strategy. Next, we surveyed and interviewed staff and patients from our neurosurgical centre to ascertain how often their craniectomy site was exposed to external pressure and the precautions taken to prevent this. 59% of patients admitted resting in contact with the craniectomy site, in agreement with the observations of 67% of staff. In 63% of these patients, this occurred on a daily basis and for some, was associated with symptoms suggestive of raised intracranial pressure. 44% of staff did not use a method to prevent craniectomy site contact while 65% utilised no additional precautions during transfer or turning. 63% of patients received no information about avoiding craniectomy site contact upon discharge, and almost all surveyed wished for resting head protection if it were available. We argue that pragmatic guidelines are needed and that our results support this perspective. As such, we offer a simple, practical protocol which can be adopted and iteratively improved as further evidence becomes available in this area.

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Evidence-Based Nursing Review of Craniectomy Care

Cited by 13 publications

References 13 publications

Physiotherapist confidence level in mobilising stroke patients after decompressive hemicraniectomy: are helmets useful?

Physiotherapist confidence level in mobilising stroke patients after decompressive hemicraniectomy: are helmets useful?

Letter by Freeman et al Regarding Article, “Evidence-Based Nursing Review of Craniectomy Care”

The Need for Head Protection Protocols for Craniectomy Patients during Rest, Transfers and Turning

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