Neurocritical care

Kramer, Andreas H.; Zygun, David

doi:10.1097/mcc.0000000000000076

Cited by 71 publications

(33 citation statements)

References 88 publications

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“…1,2,27 However, like other studies that examine the impact of neurocritical care, the implementation of our service involved a number of changes, including cEEG, as well as education for bedside physicians and nurses, and seizure management guidelines; thus, a single causal explanation for reduced medication use cannot be definitively identified.…”

Section: Discussionmentioning

confidence: 99%

“…While there is strong evidence that adults with acute neurological conditions who are treated in a specialized neurocritical unit have reduced morbidity and mortality, 1,2 the impact of neurocritical care in the neonatal population is not known. Several reasons for improved outcomes have been proposed, including: (1) higher patient volumes in designated centers, (2) adherence to protocols, and (3) multimodal neurological monitoring.…”

Section: Introductionmentioning

confidence: 99%

“…Several reasons for improved outcomes have been proposed, including: (1) higher patient volumes in designated centers, (2) adherence to protocols, and (3) multimodal neurological monitoring. 2 …”

Section: Introductionmentioning

confidence: 99%

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Neonatal Neurocritical Care Service Is Associated With Decreased Administration of Seizure Medication

et al. 2014

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This cohort study examines medication use in term neonates with hypoxic-ischemic encephalopathy (HIE) and seizures before and after implementation of a Neonatal Neurocritical Care Service (N=108), which included increased seizure monitoring. Nearly all neonates received phenobarbital (96% pre- versus 95% post-Neonatal Neurocritical Care Service) and total loading dose did not vary among groups (33 [95% CI 29–37] versus 30 [26–34] mg/kg). After adjustment for seizure burden, neonates managed during the Neonatal Neurocritical Care Service era, on average, received 30 mg/kg less cumulative phenobarbital (95% CI 15–46 mg/kg) and were on maintenance 5 fewer days (95% CI 3–8 days) than those who were treated prior to implementation of the service. In spite of the enhanced ability to detect seizures due to improved monitoring and increased vigilance by bedside practitioners, implementation of the Neonatal Neurocritical Care Service was associated with decreased use of potentially harmful phenobarbital treatment among neonates with HIE.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neonatal Neurocritical Care Service Is Associated With Decreased Administration of Seizure Medication

et al. 2014

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“…Of note, a recent meta-analysis of more than 40,000 adult patients with brain injury concluded that patients treated in a neurocritical care unit had improved mortality as well as improved neurological outcomes. The authors of the study attributed improved patient care to the specific expertise gained from health care providers in repeatedly caring for this specific patient population, reduction of unnecessary practice variation with adherence to protocols, and multi-modal neuromonitoring (19). Much remains to be learned about specific implementation strategies and metrics utilized at such centers, and their link to patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Implementation strategies in pediatric neurocritical care

Markham

Proctor

Pineda

2017

Current Opinion in Pediatrics

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Purpose of Review Brain-directed critical care for children is a relatively new area of sub specialization in Pediatric Critical Care. Pediatric neurocritical care teams combine the expertise of neurology, neurosurgery, and critical care medicine. The positive impact of delivering specialized care to pediatric patients with acute neurological illness is becoming more apparent, but the optimum way to implement and sustain the delivery of this is complicated and poorly understood. We aim to provide emerging evidence supporting that effective implementation of pediatric neurocritical care pathways can improve patient survival and outcomes. We also provide an overview of the most effective strategies across the field of implementation science that can facilitate deployment of neurocritical care pathways in the Pediatric Intensive Care Unit. Recent Findings Implementation strategies can broadly be grouped according to six categories: planning, educating, restructuring, financing, managing quality, and attending to the policy context. Using a combination of these strategies in the last decade, several institutions have improved patient morbidity and mortality. While much work remains to be done, emerging evidence supports that implementation of evidence based care pathways for critically ill children with two common neurological diagnoses-status epilepticus and traumatic brain injury-improves outcomes. Summary Pediatric and neonatal neurocritical care programs that support evidence based care can be effectively structured using appropriately sequenced implementation strategies to improve outcomes across a variety of patient populations and in a variety of health care settings.

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“…Identification of predictors most influential in ICULOS may lead to earlier intervention and control of autonomic discharges. In turn, this might facilitate the earlier use of pharmacologic neuro-stimulation, rehabilitation and expedite discharge to high level brain injury recovery programs (Wheaton, Mathias, & Vink, 2009;Whyte et al, 2013) as specialized care by neurotrauma specialists in acute care and rehabilitation is known to improve hospital outcome and the likelihood of community re-integration following TBI (Haas et al, 2009;Kramer & Zygun, 2014;Whyte et al, 2013).…”

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confidence: 99%

The impact of paroxysmal sympathetic hyperactivity following traumatic brain injury on intensive care unit length of stay and discharge disposition.

Meyer¹

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Neurocritical care

Abstract: Neurocritical care is an evolving field that is associated with improvements in outcomes over the past decade. Further research is required to determine how monitoring and treatment protocols can be optimized.

Cited by 71 publications

References 88 publications

Neonatal Neurocritical Care Service Is Associated With Decreased Administration of Seizure Medication

Neonatal Neurocritical Care Service Is Associated With Decreased Administration of Seizure Medication

Implementation strategies in pediatric neurocritical care

The impact of paroxysmal sympathetic hyperactivity following traumatic brain injury on intensive care unit length of stay and discharge disposition.

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