Neurocritical care
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Trauma, including traumatic brain injury (TBI), is the leading cause of nonobstetric maternal mortality during pregnancy. Few data are available regarding the optimal management of pregnant patients with TBI, leading to a lack of dedicated guidelines. We performed an international survey to examine the management of severe TBI in pregnant patients, focusing on monitoring, therapy, and intensive care practices. ⋯ Great variability in the management of pregnant patients with severe TBI was identified worldwide from the results of our survey. These findings, highlighting the lack of robust evidence on this topic, will be helpful to stimulate future investigations and to promote educational efforts on this difficult scenario.
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Approximately 50% of family caregivers of patients with severe acute brain injury (SABI) admitted to intensive care units experience clinically significant anxiety, depression, and posttraumatic stress. Peer-delivered interventions may be a sustainable way to provide social connection, emotional support, and evidence-based coping skills for family caregivers of patients with SABI to improve their mental health and well-being. ⋯ Our results indicated that (1) very few examples of peer-delivered interventions for this population exist, (2) all existing examples are professional-led (e.g., nurse-led) multifamily support groups, and (3) existing interventions demonstrate mixed results. Future research is needed to develop and evaluate peer-delivered interventions, including testing different models of peer-delivered interventions (e.g., one-to-one peer mentorship), programs that provide skills and support to caregivers after discharge, and skills-based formats that are tailored to the unique needs of SABI caregivers.
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Seizures occur frequently in pediatric patients with traumatic brain injury (TBI), particularly abusive head trauma (AHT). There are limited data on the effectiveness of fosphenytoin and levetiracetam to prevent posttraumatic seizures. ⋯ In children < 3 years old with TBI, no differences were observed in occurrence of seizures between patients who received fosphenytoin and patients who received levetiracetam prophylaxis after controlling for patient factors including severity of injury. Levetiracetam may be an equally effective alternative to fosphenytoin for seizure prophylaxis for early posttraumatic seizure prevention in this age group.
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The aim of this study was to develop a consensus-based set of indicators of high-quality acute moderate to severe traumatic brain injury (msTBI) clinical management that can be used to measure structure, process, and outcome factors that are likely to influence patient outcomes. This is the first stage of the PRECISION-TBI program, which is a prospective cohort study that aims to identify and promote optimal clinical management of msTBI in Australia. ⋯ This study identified a set of 32 quality indicators that can be used to structure data collection to drive quality improvement in the clinical management of msTBI. They will also be used to guide feedback to PRECISION-TBI's participating sites.
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Spontaneous intracerebral hemorrhage (ICH) is one of the most disabling forms of stroke. Intensive lowering of blood pressure (BP) has been postulated as one of the therapies that can improve functional outcomes. However, this intensive reduction is not always achieved. We aimed to study the differences between patients in whom intensive BP lowering was achieved during the first 24 h after admission and those in whom this BP lowering was not possible. ⋯ In this study, the intensive BP-lowering goal was not achieved in about half of the patients with ICH, despite the high proportion of patients receiving antihypertensive medications. This group of patients had poorer outcomes and higher mortality rates at 3 months. High BP at presentation may be difficult to control in patients with high clinical severity of ICH despite aggressive management.