Current opinion in critical care
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Curr Opin Crit Care · Apr 2014
ReviewNursing collaboration: a key element in debunking neurocritical care myths.
To explore the origin of myths and their progression toward dogma. The process of debunking myths in the neurocritical care unit (NCCU) is facilitated if nurses are involved early during the process. ⋯ Myth and dogma are problems confronted in all of medicine and here we provide specific examples from the NCCU. Nursing care, especially in the ICU, can help identify these myths and, in conjunction with physicians, tests these myths via the scientific method instead of accepting the null hypothesis. Even when myths are proven false, changing clinical practice, altering physician or nurse behavior, and fighting dogma remain a challenge.
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Spontaneous intracerebral haemorrhage (ICH) imposes a significant health and economic burden on society. Despite this, ICH remains the only stroke subtype without a definitive treatment. Without a clearly identified and effective treatment for spontaneous ICH, clinical practice varies greatly from aggressive surgery to supportive care alone. This review will discuss the current modalities of treatments for ICH including preliminary experience and investigative efforts to advance the care of these patients. ⋯ ICH lacks a definitive primary treatment as well as a therapy targeting surrounding perihematomal oedema and associated secondary damage. An ongoing phase III trial using MIS techniques shows promise for providing treatment for these patients.
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Curr Opin Crit Care · Apr 2014
ReviewFever and therapeutic normothermia in severe brain injury: an update.
Fever is common in the ICU among patients with severe brain injury. Fever has been consistently shown to exacerbate brain injuries in animal models and has been consistently associated with poor outcome in human studies. However, whether fever control improves outcome and the ideal means of fever control remain unknown. This review will address recent literature on the impact of fever on severe brain injury and on interventions to maintain normothermia. ⋯ The value of therapeutic normothermia in the neurocritical care unit (NCCU) is increasingly accepted, yet prospective trials that demonstrate a functional benefit to patients are lacking.
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Data from MRI can be used to generate detailed maps of central nervous system anatomy and functional activation. Here, we review new research that integrates advanced MRI acquisition and analysis to predict and track recovery following severe traumatic brain injury (TBI) or anoxic ischemic encephalopathy (AIE) following cardiac arrest. ⋯ MRI of the brain is feasible in critically ill patients following TBI or cardiac arrest, revealing patterns of structural damage and functional disconnection that can help predict outcome in the long term. Prospective studies are needed to validate these findings and to identify relationships between MRI-defined alterations and specific postinjury cognitive and behavioural phenotypes.