In-Hospital Mortality From Cerebrovascular Disease

Fustes, Otto Jesús Hernández; Rodriguez, Carlos Arteaga; Fustes, Olga Judith Hernandez

doi:10.7759/cureus.8652

Cited by 7 publications

(9 citation statements)

References 17 publications

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“…Neurologic complications can and do occur in patients with or without a primary neurologic diagnosis. 5,6 This includes transient neurologic conditions as well as severe complications. For example, patients admitted to a MICU, SICU, or CVICU are at increased risk for developing delirium secondary to a host of health care-associated events.…”

Section: Introductionmentioning

confidence: 99%

Original Research: Practice Variations in Documenting Neurologic Examinations in Non-Neuroscience ICUs

Banzon

Vashisht

Euckert

et al. 2023

AJN, American Journal of Nursing

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Patients admitted to an ICU require constant monitoring to assess the need for and effectiveness of interventions. Comprehensive serial assessments are important for timely diagnosis, detection of status changes, treatment planning, monitoring patient response, and optimal patient outcomes. 1 The neurologic examination (neuro exam) is a vital part of such assessments. A comprehensive neuro exam includes assessing seven domains: consciousness, injury severity, speech, cranial nerve function, pain, motor function, and sensory function. 2 The neuro exam is performed to assess for deterioration in a patient's consciousness and to detect new focal neurologic deficits, which can happen quickly and may result in worsened short-or long-term morbidity. 3 Documentation is a critical part of team members' communication across shift handoffs and level-ofcare transitions. Yet the degree to which both the performance and the documentation of the neuro exam correlate is not well established. Moreover, while a comprehensive neuro exam is commonly required for patients admitted to a neuroscience ICU, some form of a neuro exam is recommended for patients in all ICUs. 4 There has been little research examining which components of the neuro exam are assessed in the medical ICU (MICU), surgical An observational study reveals differences in charting by RNs versus providers.ICU (SICU), and cardiovascular ICU (CVICU), where patients with primary neurologic problems are admitted less often. 4Study purpose. This study examined documentation practices to identify the frequency and components of the neuro exam typically documented by RNs and by providers when caring for patients in the MICU, SICU, and CVICU. (For this study, providers included medical fellows and resident or attending physicians, NPs, and physician assistants.) BACKGROUNDNeurologic complications can and do occur in patients with or without a primary neurologic diagnosis. 5,6 This includes transient neurologic conditions as well as severe complications. For example, patients admitted to a MICU, SICU, or CVICU are at increased risk for developing delirium secondary to a host of health care-associated events. 7,8 In more extreme cases, a postsurgical CVICU patient could experience acute ischemic stroke, or a MICU patient's level of consciousness could progress to coma as a result of metabolic derangements. 9, 10 Clearly, neuro exams are critical to patient care in every ICU.In the neuroscience ICU, the neuro exam is typically highly detailed, designed to evaluate the functional status of every component of the ner-

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Section: Introductionmentioning

confidence: 99%

Original Research: Practice Variations in Documenting Neurologic Examinations in Non-Neuroscience ICUs

Banzon

Vashisht

Euckert

et al. 2023

AJN, American Journal of Nursing

View full text Add to dashboard Cite

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“…Ischemic stroke is a major cause of death and disability. In patients hospitalized for ischemic stroke, respiratory complications are among the most common causes of morbidity and mortality 1 2. Patients who had stroke have a relatively high risk of respiratory failure given frequent frailty, comorbid conditions, reduced awareness, and impaired motor control of swallowing and cough.…”

Section: Introductionmentioning

confidence: 99%

Transesophageal echocardiography and risk of respiratory failure in patients who had ischemic stroke or transient ischemic attack: an IDEAL phase 4 study

Bruce

Navi

Zhang

et al. 2022

BMJ Surg Interv Health Technologies

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ObjectiveTransesophageal echocardiography (TEE) is sometimes used to search for cardioembolic sources after ischemic stroke or transient ischemic attack (TIA). TEE visualizes some sources better than transthoracic echocardiography, but TEE is invasive and may cause aspiration. Few data exist on the risk of respiratory complications after TEE in patients who had stroke or TIA. Our objective was to determine whether TEE was associated with increased risk of respiratory failure in patients who had ischemic stroke or TIA.DesignThis is a retrospective cohort study using administrative data from inpatient and outpatient insurance claims collected by the US federal government’s Centers for Medicare and Medicaid Services.SettingHospitals and outpatient clinics throughout the USA.Participants99 081 patients ≥65 years old hospitalized for out-of-hospital ischemic stroke or TIA, defined by validated International Classification of Disease-9/10 diagnosis codes and present-on-admission codes, using claims data from 2008 to 2018 in a random 5% sample of Medicare beneficiaries.Main outcome measuresAcute respiratory failure, defined as endotracheal intubation and/or mechanical ventilation, starting on the first day after admission through 28 days afterward.ResultsOf 99 081 patients included in this analysis, 73 733 (74.4%) had an ischemic stroke and 25 348 (25.6%) a TIA. TEE was performed in 4677 (4.7%) patients and intubation and/or mechanical ventilation in 1403 (1.4%) patients. The 28-day cumulative risk of respiratory failure after TEE (1.4%; 95% CI 0.8% to 2.7%) was similar to that seen in those without TEE (1.4%; 95% CI 1.4% to 1.5%) (p=0.84). After adjustment for age, sex, race, Charlson comorbidities, diagnosis of stroke versus TIA, intravenous thrombolysis, and mechanical thrombectomy, TEE was not associated with an increased risk of respiratory failure (HR, 0.9; 95% CI 0.6 to 1.2).ConclusionsIn a cohort of older patients who had ischemic stroke or TIA, TEE was not associated with an increased risk of subsequent respiratory failure.

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“…At present, the main treatment methods for cerebrovascular diseases (such as cerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage) were surgical treatment and drug treatment ( DeBaun et al, 2020 ; Hernandez Fustes et al, 2020 ; Sturiale et al, 2020 ). Of these, there are three main types of conventional drug therapy: 1) antihypertensive and antidiabetic drugs, such as nifedipine, valsartan, and metformin; 2) anticoagulant therapy, such as aspirin and warfarin; 3) symptomatic treatment of cognitive, emotional, and mental disorders, such as memantine hydrochloride, oxiracetam, and clozapine ( Jiang et al, 2020 ; Li T. et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Anticonstriction Effect of MCA in Rats by Danggui Buxue Decoction

et al. 2021

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Objective: Danggui Buxue decoction (DBD), consisting of Angelicae Sinensis Radix (ASR) and Astragali Radix (AR), is a famous prescription with the function of antivasoconstriction. This study intends to probe its mechanisms on the relaxation of the middle cerebral artery (MCA).Methods: Vascular tension of rat MCA was measured using a DMT620 M system. First, the identical series of concentrations of DBD, ASR, and AR were added into resting KCl and U46619 preconstricted MCA. According to the compatibility ratio, their dilatation effects were further investigated on KCl and U46619 preconstricted vessels. Third, four K+ channel blockers were employed to probe the vasodilator mechanism on KCl-contracted MCA. We finally examined the effects of DBD, ASR, and AR on the vascular tone of U46619-contracted MCA in the presence or absence of Ca2+.Results: Data suggested that DBD, ASR, and AR can relax on KCl and U46619 precontracted MCA with no effects on resting vessels. The vasodilator effect of ASR was greater than those of DBD and AR on KCl-contracted MCA. For U46619-contracted MCA, ASR showed a stronger vasodilator effect than DBD and AR at low concentrations, but DBD was stronger than ASR at high concentrations. Amazingly, the vasodilator effect of DBD was stronger than that of AR at all concentrations on two vasoconstrictors which evoked MCA. The vasodilator effect of ASR was superior to that of DBD at a compatibility ratio on KCl-contracted MCA at low concentrations, while being inferior to DBD at high concentrations. However, DBD exceeded AR in vasodilating MCA at all concentrations. For U46619-constricted MCA, DBD, ASR, and AR had almost identical vasodilation. The dilation of DBD and AR on KCl-contracted MCA was independent of K+ channel blockers. However, ASR may inhibit the K+ channel opening partially through synergistic interactions with Gli and BaCl2. DBD, ASR, and AR may be responsible for inhibiting [Ca2+]out, while ASR and AR can also inhibit [Ca2+]in.Conclusion: DBD can relax MCA with no effects on resting vessels. The mechanism may be related to ASR’s inhibition of KATP and Kir channels. Meanwhile, the inhibition of [Ca2+]out by DBD, ASR, and AR as well as the inhibition of [Ca2+]in by ASR and AR may contribute to dilate MCA.

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In-Hospital Mortality From Cerebrovascular Disease

Cited by 7 publications

References 17 publications

Original Research: Practice Variations in Documenting Neurologic Examinations in Non-Neuroscience ICUs

Original Research: Practice Variations in Documenting Neurologic Examinations in Non-Neuroscience ICUs

Transesophageal echocardiography and risk of respiratory failure in patients who had ischemic stroke or transient ischemic attack: an IDEAL phase 4 study

Anticonstriction Effect of MCA in Rats by Danggui Buxue Decoction

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