Significant Practice Pattern Variations Associated With Intracranial Pressure Monitoring

Olson, DaiWai M.; Lewis, Lisa S.; Bader, Mary Kay; Bautista, Cynthia; Malloy, Rachel; Riemen, Kristina; McNett, Molly

doi:10.1097/jnn.0b013e3182986400

Cited by 23 publications

(10 citation statements)

References 18 publications

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“…1 Briefly, patients were a mean of 47 years old, primarily male (68%), and 75% were white. Admission diagnoses were primarily subarachnoid hemorrhage (21%), intracerebral hemorrhage (32%), and traumatic brain injury (21%).…”

Section: Resultsmentioning

confidence: 99%

“…Recent research highlights the wide practice variations associated with monitoring, treating, and documenting ICP values in the intensive care unit (ICU). 1 The most common methods of ICP monitoring are a tunneled ventriculostomy catheter, a bolt-secured intraventricular catheter, or an intraparenchymal catheter.…”

Section: Methodsmentioning

confidence: 99%

“…The SIM City (Study of ICP Monitoring in Critically Ill) study was a multicenter observational study; the methods and initial results describing practice variation associated with ICP monitoring are reported elsewhere. 1 The SIM City study was a prospective observational study approved by an institutional review board. Patients at participating hospitals were considered eligible if they were adults (>18 years old) with ICP monitoring for a neurological injury and they were admitted to an ICU.…”

Section: Methodsmentioning

confidence: 99%

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Effects of Nursing Interventions on Intracranial Pressure

Olson

McNett

Lewis

et al. 2013

American Journal of Critical Care

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Background Intracranial pressure is a frequent target for goaldirected therapy to prevent secondary brain injury. In critical care settings, nurses deliver many interventions to patients having intracranial pressure monitored, yet few data documenting the immediate effect of these interventions on intracranial pressure are available. Objective To examine the relationship between intracranial pressure and specific nursing interventions observed during routine care. Methods Secondary analysis of prospectively collected observational data. Results During 3118 minutes of observation, 11 specific nursing interventions were observed for 28 nurse-patient dyads from 16 hospitals. Family members talking in the room, administering sedatives, and repositioning the patient were associated with a significantly lower intracranial pressure. However, intracranial pressure was sometimes higher, lower, or unchanged after each intervention observed. Conclusion Response of intracranial pressure to nursing interventions is inconsistent. Most interventions were associated with inconsistent changes in intracranial pressure at 1 or 5 minutes after the intervention.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Effects of Nursing Interventions on Intracranial Pressure

Olson

McNett

Lewis

et al. 2013

American Journal of Critical Care

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“…2 Furthermore, Olson et al 16 reported high practice variation among 14 hospitals participating in an observational study of ICP monitoring.…”

mentioning

confidence: 99%

Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage

Olson

Zomorodi

Britz

et al. 2013

JNS

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Object Cerebral artery vasospasm is a major cause of death and disability in patients recovering from subarachnoid hemorrhage (SAH). Although the exact cause of vasospasm is unknown, one body of research suggests that clearing blood products by CSF drainage is associated with a lower frequency and severity of vasospasm. There are multiple approaches to facilitating CSF drainage, but there is inadequate evidence to determine the best practice. The purpose of this study was to explore whether continuous or intermittent CSF drainage was superior for reducing vasospasm. Methods The authors performed a randomized clinical trial. Within 72 hours of admission for SAH, patients with an external ventricular drain (EVD) were randomized to undergo continuous CSF drainage with intermittent intracranial pressure (ICP) monitoring (open-EVD group) or continuous ICP monitoring with intermittent CSF drainage (monitor-ICP group). Results After 60 patients completed the study, an interim analysis was performed. The complication rate of 52.9% for the open-EVD group was significantly higher than the 23.1% complication rate for the monitor-ICP group (OR 3.75, 95% CI 1.21–11.66, p = 0.022). These results were reported to the Data Safety and Monitoring Board and enrollment was terminated. The odds ratio of vasospasm for the open-EVD versus monitor-ICP group was not significant (OR 0.44, 95% CI 0.13–1.45, p = 0.177). Conclusions Continuous CSF drainage with intermittent ICP monitoring is associated with a higher rate of complications than continuous ICP monitoring with intermittent CSF drainage, but there is no difference between the two types of monitoring in vasospasm. Clinical trial registration no.: NCT01169454 (clinicaltrials.gov).

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“…42 Studies have demonstrated that when ICP is unresponsive to medical therapy, there is an increase in poor outcome. [43][44][45][46][47][48][49] Recent literature has begun to question the practice variation in ICP monitoring, 50,51 and the optimal target for interventions aimed to treat ICP. 52…”

Section: Intracranial Pressurementioning

confidence: 99%