Rehabilitation outcome of patients with severe and prolonged disorders of consciousness after aneurysmal subarachnoid hemorrhage (aSAH)

Klein, Anke-Maria; Howell, Kaitlen; Straube, Andreas; Pfefferkorn, Thomas; Bender, Andreas

doi:10.1016/j.clineuro.2013.08.004

Cited by 31 publications

(22 citation statements)

References 27 publications

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“…Evidence showed that most of the functional recovery after TBI occurs in the first 6 months after the injury, a period too long to verify the decisive results of a rehabilitation intervention occurring in the first weeks of hospitalization (39). Studies on patients with cerebral haemorrhage have shown that significant improvements (measured by means of FIM and CRS) could be detected, on average, after 11 and 9 weeks from admission to neurorehabilitation, for patients diagnosed with a vegetative state or minimally conscious states, respectively (40). This suggests that neurological outcomes should be measure over a longer time-frame than our study, and may explain why the studies on patients with sABI are performed mainly in a subsequent phase after the ICU stay, during patients' admission to rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Mobilization in early rehabilitation in intensive care unit patients with severe acquired brain injury: An observational study

Bartolo¹,

Bargellesi

Castioni

et al. 2017

J Rehabil Med

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Section: Discussionmentioning

confidence: 99%

Mobilization in early rehabilitation in intensive care unit patients with severe acquired brain injury: An observational study

Bartolo¹,

Bargellesi

Castioni

et al. 2017

J Rehabil Med

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“…According to published papers, decannulation can be performed in ICU, 4 5 6 7 8 in neurosurgical units, 9 in long-term care hospitals, 10 11 12 and, less frequently, in rehabilitation medicine units. 13 14 15 The papers also suggest that the possibility of performing the removal for sABI patients in a neurorehabilitation ward (NW) is rated as variable. 12 13 14 15 …”

Section: Introductionmentioning

confidence: 99%

Parameters Influencing Tracheostomy Decannulation in Patients Undergoing Rehabilitation after severe Acquired Brain Injury (sABI)

Perin

Meroni

Rega

et al. 2017

Int Arch Otorhinolaryngol

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Introduction Tracheostomy weaning in patients who suffered a severe acquired brain injury is often a challenge and decannulation failures are not uncommon. Objective Our study objective is to describe the decannulation failure rate in patients undergoing rehabilitation following a severe acquired brain injury (sABI); to describe the factors associated with a successful tube weaning. Methods We conduct a retrospective analysis of charts, consecutively retrieved considering a 3-year window. Variables analyzed were: age, sex, body mass index (BMI), Glasgow Coma Scale (GCS), cause of hospitalization (stroke, trauma, cardiac arrest), date of the pathological event, gap between the index event and the first day of hospitalization, duration of Neurorehabilitation Ward hospitalization, comorbidities, chest morphological alteration, kind of tracheostomy tube used (overall dimension, cap, fenestration), SpO2, presentation and quantification of pulmonary secretion, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), respiratory frequency and pattern, cardiac frequency, presence of spontaneous cough, cough strength, and blood gas analysis. Results We analyzed 45 tracheostomised sABI patients following stroke, trauma, or cardiac arrest. The weaning success percentage was higher in Head Trauma patients and in patients presenting positive spontaneous cough. Failures seem to be associated with presence of secretions and anoxic brain damage. GCS seemed not related to the decannulation outcome. Conclusions Parameters that could be used as positive predictors of weaning are: mean expiratory pressure, presence of spontaneous cough, and cough strength. Provoked cough and GCS were not predictive of weaning success.

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“…Spontaneous subarachnoid hemorrhage (SAH) is an acute brain injury that frequently leaves patients comatose and can lead to poor outcomes. [ 8 , 9 ] Comatose patients may appear like a black box to clinicians for whom it is difficult to determine if their patient is improving or requires changes to their treatment. ICU patients generate hundreds of thousands of physiologic data points during their ICU course representing a number of different physiologic and pathophysiologic processes.…”

Section: Introductionmentioning

confidence: 99%

Causal Structure of Brain Physiology after Brain Injury from Subarachnoid Hemorrhage

et al. 2016

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High frequency physiologic data are routinely generated for intensive care patients. While massive amounts of data make it difficult for clinicians to extract meaningful signals, these data could provide insight into the state of critically ill patients and guide interventions. We develop uniquely customized computational methods to uncover the causal structure within systemic and brain physiologic measures recorded in a neurological intensive care unit after subarachnoid hemorrhage. While the data have many missing values, poor signal-to-noise ratio, and are composed from a heterogeneous patient population, our advanced imputation and causal inference techniques enable physiologic models to be learned for individuals. Our analyses confirm that complex physiologic relationships including demand and supply of oxygen underlie brain oxygen measurements and that mechanisms for brain swelling early after injury may differ from those that develop in a delayed fashion. These inference methods will enable wider use of ICU data to understand patient physiology.

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Rehabilitation outcome of patients with severe and prolonged disorders of consciousness after aneurysmal subarachnoid hemorrhage (aSAH)

Cited by 31 publications

References 27 publications

Mobilization in early rehabilitation in intensive care unit patients with severe acquired brain injury: An observational study

Mobilization in early rehabilitation in intensive care unit patients with severe acquired brain injury: An observational study

Parameters Influencing Tracheostomy Decannulation in Patients Undergoing Rehabilitation after severe Acquired Brain Injury (sABI)

Causal Structure of Brain Physiology after Brain Injury from Subarachnoid Hemorrhage

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