The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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Clinical Trial
Effect of body position on cerebral oxygenation and physiologic parameters in patients with acute neurological conditions.
How body position influences brain tissue oxygen (PbtO2) and intracranial pressure (ICP) in critically ill neurosurgical patients remains poorly defined. In a prospective observational repeated measures study, we examined the effects of 12 different body positions on neurodynamic and hemodynamic outcomes. Thirty-three consecutive patients (mean +/- SD, age = 48.3 +/- 16.6 years; 22 men), admitted after traumatic brain injury, subarachnoid hemorrhage, or craniotomy for tumor, were evaluated in a neurocritical care unit at a level 1 academic trauma center. ⋯ Hemodynamic parameters were similar in the various positions. Positioning practices can positively or negatively affect PbtO2 and ICP and fluctuate with considerable variability among patients. Nurses must consider potential effects of turning, evaluate changes with positioning on the basis of monitoring feedback from multimodality devices, and make independent clinical judgments about optimal positions to maintain or improve cerebral oxygenation.
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This study was undertaken to evaluate whether significant alterations in serum osmolality, [Na+], and [K+] occur after the repeated dosing of mannitol and whether these imbalances increased accordingly with the progress of mannitol application. This study was conducted by performing a retrospective medical record review of brain injury patients who were admitted to the neurological intensive care units of a university hospital located in Incheon, South Korea. Data on intracranial pressure and serum [Na+], [K+], and osmolality levels were collected from the first to the seventh day of mannitol administration. ⋯ Our findings appear to provide clear evidence of electrolyte imbalances after repeated mannitol administration. Accordingly, careful monitoring of electrolyte status is essential when repeated doses of mannitol are given. We recommend that the practice of administering repeated dose of mannitol for prophylactic purposes be reevaluated.
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The primary mission of any intensive care unit (ICU) is to provide critically ill patients with high-quality care and an atmosphere in which to recuperate. However, all too often, the intensive environment, which is often busy, chaotic, and noisy, may contribute to just the opposite. Patients overstimulated with noise, lights, and other distractions often suffer from sleep deprivation. ⋯ Patients' sleep behavior was recorded every half hour, beginning 1/2 hour before quiet time until 30 minutes after. Analysis of data, adjusted for multiple testing and repeated measures on patients, demonstrated significantly lower noise and light levels during day shift quiet time. In addition, patients were significantly more likely to be observed sleeping during day shift quiet time hours.
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Randomized Controlled Trial Multicenter Study
Multicenter pilot study: safety of automated chest percussion in patients at risk for intracranial hypertension.
In the critical care setting, the focus of care during the first few weeks following acute brain injury is prevention of secondary brain injury by optimizing cerebral perfusion. Ensuring adequate oxygenation and perfusion of cerebral tissues requires attention to all of the body systems. Chest percussion therapy (CPT) promotes pulmonary hygiene and optimizes gas exchange by opening the alveoli. ⋯ Each patient was randomized to receive automated CPT (using specialty beds) for 10 minutes, starting at 10, 20, 30, or 40 minutes into the hour. There were no differences in mean ICP values before, during, or after CPT. This study provides evidence that it is safe to perform CPT in patients with ICP monitoring in situ.