Journal of the neurological sciences
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In order to meet the needs of the high acuity population in today's critical care environment, the role of the Acute Care Nurse practitioner (ACNP) has been adopted by many intensive care units (ICU's) across the country, including specialized neurocritical care units. In this chapter we will provide a brief historical review of the ACNP as well as their function in various ICU settings. Lastly, we will describe the current role of the ACNP in the Neurosciences Critical Care Unit at the Johns Hopkins Hospital as well as future plans and challenges of the role.
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Hypothermia has recently been shown to be beneficial in certain clinical settings of acute brain injury, such as cardiac arrest. The available technology to induce and maintain this state is advancing quickly. This review will focus on the current state of available technology and devices as well as their limitations in attaining this potentially neuroprotective state. Furthermore, we will present the efficacy of the individual systems as well as potential side effects and complications that are associated with the technology chosen.
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In 2000, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) introduced the mandate for the implementation of standards for both pain assessment and need for therapy in hospitalized patients. The need for the appropriate titration of sedation and analgesia is particularly poignant in an intensive care unit (ICU) setting where iatrogenic discomfort often complicates patient management. ⋯ Hence, maximal comfort without diminishing neurological responsiveness is desirable. Here, we review the frequently applied methods of evaluating levels of pain and agitation in critically ill patients as well as discuss the appropriate classes of pharmaceutical agents common to this population, with particular emphasis on the potential neurophysiological impact of such therapy.
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Review
Monitoring brain tissue oxymetry: will it change management of critically ill neurologic patients?
Based on the assumption that brain ischemia and hypoxia are central causes of brain damage, the maintenance of an adequate tissue oxygenation is a primary objective in the field of neurocritical care. Thus, monitoring brain tissue oxymetry, allowing the possibility to discriminate between normal and critically impaired tissue oxygenation, is recognized as an essential part of the management of the neurological critically ill patient. The clinical usefulness of this neuromonitoring tool in the area of neurosciences (traumatic brain injury, aneurysm surgery, arteriovenous malformation resection, brain tumors) is discussed. ⋯ It can also be used as a "surrogate end point" to evaluate putative therapies, targeting therapy towards improved cerebral oxygenation. As brain tissue oxygenation correlates closely with outcome, several outcome categories have been differentiated, aiding in predicting prognosis after injury. The rationale for monitoring brain tissue oxygenation is to provide essential information about oxygen supply and utilization in this specific tissue bed, thus reducing secondary brain damage and improving neurological outcome.
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Fever is common in a variety of neurological disorders. There is abundant experimental evidence suggesting that fever leads to, or exacerbates, neuronal injury in conditions such as cerebral ischemia and traumatic brain injury. ⋯ Recently, several new devices to control temperature have become available. These devices appear to be more effective than conventional means and might allow us to design studies that definitively answer the question: "Does controlling fever improve outcome?"