Reassessing hourly neurochecks

LaBuzetta, Jamie Nicole; Malhotra, Atul

doi:10.1016/j.jocn.2023.02.009

Cited by 7 publications

(13 citation statements)

References 24 publications

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“…10 When determining the frequency of checks, the potential for immediate worsening must be balanced with concerns for delirium and agitation. 41 When unable to follow the clinical examination, additional monitoring with serial imaging, EEG, invasive and noninvasive ICP monitoring, and other modalities may be indicated (TABLE [1][2][3].…”

Section: Detecting Deteriorationmentioning

confidence: 99%

“…Ideally, the clinical examination of patients with a high risk of deterioration should be monitored in an intensive care unit by clinicians trained in neurocritical care and experienced with this population 10 . When determining the frequency of checks, the potential for immediate worsening must be balanced with concerns for delirium and agitation 41 . When unable to follow the clinical examination, additional monitoring with serial imaging, EEG, invasive and noninvasive ICP monitoring, and other modalities may be indicated ( table 1-3 ).…”

Section: Detecting Deteriorationmentioning

confidence: 99%

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The Neurocritical Care Examination and Workup

Wahlster,

Johnson

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article provides an overview of the evaluation of patients in neurocritical care settings and a structured approach to recognizing and localizing acute neurologic emergencies, performing a focused examination, and pursuing workup to identify critical findings requiring urgent management. LATEST DEVELOPMENTS After identifying and stabilizing imminent threats to survival, including respiratory and hemodynamic compromise, the initial differential diagnosis for patients in neurocritical care is built on a focused history and clinical examination, always keeping in mind critical “must-not-miss” pathologies. A key priority is to identify processes warranting time-sensitive therapeutic interventions, including signs of elevated intracranial pressure and herniation, acute neurovascular emergencies, clinical or subclinical seizures, infections of the central nervous system, spinal cord compression, and acute neuromuscular respiratory failure. Prompt neuroimaging to identify structural abnormalities should be obtained, complemented by laboratory findings to assess for underlying systemic causes. The indication for EEG and lumbar puncture should be considered early based on clinical suspicion. ESSENTIAL POINTS In neurocritical care, the initial evaluation is often fast paced, requiring assessment and management to happen in parallel. History, clinical examination, and workup should be obtained while considering therapeutic implications and the need for lifesaving interventions.

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Section: Detecting Deteriorationmentioning

confidence: 99%

Section: Detecting Deteriorationmentioning

confidence: 99%

The Neurocritical Care Examination and Workup

Wahlster,

Johnson

2024

CONTINUUM: Lifelong Learning in Neurology

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“…Neurologic assessment hourly or every 2 hours is common in neurocritical care units, although data describing actual practice over the course of the ICU stay are limited to single health systems and varies. 8 9 There is a growing concern that frequent neuromonitoring, particularly beyond 1 to 2 days may disrupt sleep–wake cycles and consequently negatively impact cognition, immunity, and weaning from mechanical ventilation, 10 as well as lead to an increased rate of delirium. 11 Additionally, very frequent assessment may be associated with diminished returns after the first 24 to 48 hours of care.…”

Section: Neurocritical Care Nursing Interventions: Published Guidancementioning

confidence: 99%

Nursing Interventions in Neurocritical Care

Livesay

2024

Semin Neurol

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Highly educated and skilled nursing care is critical to improving patient outcomes in general and in specialties like neurocritical care. Nursing interventions reflect nursing knowledge, critical thinking, and decision-making and is generally rooted in the nursing process. Nursing interventions are also a key focus of research to better understand how nursing care influences patient outcomes. This review describes the literature regarding nursing interventions in key neurocritical diagnoses and contextualizes it within the broader discussion about the nursing process and nursing interventions research. Publications about nursing interventions in neurocritical care emphasize key themes, including managing neurophysiologic parameters, providing psychosocial support, managing the environmental milieu, and interventions to prevent complications. Further study of how to best support nurses in collecting and interpreting data to form nursing interventions is needed, as is understanding the benefits and limitations of the nursing process in low- and middle-income countries.

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“…[10][11][12] For mild and moderate TBI patients, the ramifications of Q1-NE disturbances to sleep-wake cycle remain controversial and undefined. 13 One potential is the harm of delirium, which is directly associated with increased LOS and worsened recovery in ICU patients. [14][15][16] In addition, the sleep deprivation resulting from extended periods of intensive nursing care and monitoring may exacerbate even further this situation.…”

mentioning

confidence: 99%

“…[14][15][16] In addition, the sleep deprivation resulting from extended periods of intensive nursing care and monitoring may exacerbate even further this situation. 13,[17][18][19][20] This study aimed to evaluate whether there is a correlation between prolonged intervals of Q1-NE and development of delirium in geriatric trauma patients with mild or moderate TBI. In addition, we aim to determine the potential benefit of conducting Q1-NE to identify conditions requiring emergent neurosurgical intervention in this specific population.…”

mentioning

confidence: 99%

Prolonged hourly neurological examinations are associated with increased delirium and no discernible benefit in mild/moderate geriatric traumatic brain injury

Fonseca,

Canas,

Diaz

et al. 2024

J Trauma Acute Care Surg

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Background Serial neurologic examinations (NE) are routinely recommended in the ICU within the first 24 hours following a TBI. There are currently no widely accepted guidelines for the frequency of NE. Disruptions to the sleep-wake cycles increase the delirium rate. We aimed to evaluate whether there is a correlation between prolonged Q1-NE and development of delirium and to determine if this practice reduces the likelihood of missing the detection of a process requiring emergent intervention. Methods Retrospective analysis of patients with mild/moderate TBI, admitted to the ICU with serial-NE. Cohorts were stratified by the duration of exposure to Q1-NE, into Prolonged(≥24 h) and Not Prolonged(<24 h). Our primary outcomes of interest was delirium, evaluated using the Confusion Assessment Method (CAM-ICU), radiological progression from baseline images, neurological deterioration (focal neurological deficit, abnormal pupillary exam, or GCS decrease >2), and neurosurgical procedures. Results A total of 522 patients were included. No significant differences were found in demographics. Patients in the Prolonged Q1-NE group (26.1%) had higher ISS with similar AIS Head, and significantly higher delirium rate [59% vs 35%, p < .001], and a longer Hospital/ICU length of stay when compared to the Not Prolonged Q1-NE group. No neurosurgical interventions were found to be performed emergently as a result of findings on NE. Multivariate analysis demonstrated that Prolonged Q1-NE was the only independent risk factor associated with a 2.5-fold increase in delirium rate. The Number Needed to Harm for prolonged Q1-NE was 4. Conclusions Geriatric patients with mild/moderate TBI exposed to Q1-NE for periods longer than 24 h had nearly a 3-fold increase in ICU-Delirium rate. One out of five patients exposed to prolonged Q1-NE is harmed by the development of delirium. No patients were found to directly benefit as a result of more frequent neurological examinations.

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Reassessing hourly neurochecks

Cited by 7 publications

References 24 publications

The Neurocritical Care Examination and Workup

The Neurocritical Care Examination and Workup

Nursing Interventions in Neurocritical Care

Prolonged hourly neurological examinations are associated with increased delirium and no discernible benefit in mild/moderate geriatric traumatic brain injury

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