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US Practitioner Attitudes Toward Tracheostomy Timing, Benefits, Risks, and Techniques for Severe Stroke Patients: A National Survey and National Inpatient Sample Analysis
Source: Neurocritical Care - October 22, 2020 Category: Neurology Source Type: research

Outcomes After Tracheostomy in Patients with Severe Acute Brain Injury: A Systematic Review and Meta-Analysis
ConclusionsOur findings suggest that about one in three patients with SABI who undergo tracheostomy may eventually achieve independence. Future research is needed to understand the reasons for the heterogeneity between studies and to identify those patients with promising outcomes as well as factors influencing outcome.
Source: Neurocritical Care - October 9, 2020 Category: Neurology Source Type: research

Use of a Novel Negative-Pressure Tent During Bedside Tracheostomy in COVID-19 Patients
ConclusionsIt is feasible to perform PDT on intubated COVID-19 patients using the AerosolVE negative-pressure tent. This is a promising low-cost device to decrease risk to healthcare providers during AGPs.
Source: Neurocritical Care - August 6, 2020 Category: Neurology Source Type: research

A Pilot Study of Pharyngeal Electrical Stimulation for Orally Intubated ICU Patients with Dysphagia
ConclusionAlthough limited by its small size and non-blinded design, this is the first study demonstrating the benefits of PES in ICU patients still orally intubated, thus offering a potential new method to reduce morbidity, mortality, and economic burden in a mixed ICU population. In order to further investigate and strengthen our findings, a statistically powered, randomized controlled study is recommended.
Source: Neurocritical Care - March 19, 2020 Category: Neurology Source Type: research

Practical approach to respiratory emergencies in neurological diseases
AbstractMany neurological diseases may cause acute respiratory failure (ARF) due to involvement of bulbar respiratory center, spinal cord, motoneurons, peripheral nerves, neuromuscular junction, or skeletal muscles. In this context, respiratory emergencies are often a challenge at home, in a neurology ward, or even in an intensive care unit, influencing morbidity and mortality. More commonly, patients develop primarily ventilatory impairment causing hypercapnia. Moreover, inadequate bulbar and expiratory muscle function may cause retained secretions, frequently complicated by pneumonia, atelectasis, and, ultimately, hypoxe...
Source: Neurological Sciences - December 1, 2019 Category: Neurology Source Type: research

Predictive value of serum creatinine/cystatin C in neurocritically ill patients
ConclusionsSerum Cr/CysC ratio at admission could be used as a predictor of long ‐term poor prognosis in neurocritically ill patients.
Source: Brain and Behavior - November 7, 2019 Category: Neurology Authors: Shengnan Wang, Ling Xie, Jiawei Xu, Yanhong Hu, Yongming Wu, Zhenzhou Lin, Suyue Pan Tags: ORIGINAL RESEARCH Source Type: research

Predictors for Tracheostomy with External Validation of the Stroke-Related Early Tracheostomy Score (SETscore)
ConclusionsSETscore is a simple score with a moderate accuracy and with a fair AUC used to predict the need for TR after MV for IS, ICH, and SAH patients. Our study also demonstrates that early TR was associated with a lower ICU LOS and VD in our cohort. The utility of this score may be improved when including additional variables such as BMI, AA race, ICH, and positive sputum cultures.
Source: Neurocritical Care - August 30, 2018 Category: Neurology Source Type: research

Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial
Publication date: Available online 28 August 2018Source: The Lancet NeurologyAuthor(s): Rainer Dziewas, Rebecca Stellato, Ingeborg van der Tweel, Ernst Walther, Cornelius J Werner, Tobias Braun, Giuseppe Citerio, Mitja Jandl, Michael Friedrichs, Katja Nötzel, Milan R Vosko, Satish Mistry, Shaheen Hamdy, Susan McGowan, Tobias Warnecke, Paul Zwittag, Philip M Bath, Tobias Braun, Rainer Dziewas, Michael FriedrichsSummaryBackgroundDysphagia after stroke is common, especially in severely affected patients who have had a tracheotomy. In a pilot trial, pharyngeal electrical stimulation (PES) improved swallowing function in this ...
Source: The Lancet Neurology - August 29, 2018 Category: Neurology Source Type: research

Use and Timing of Tracheostomy After Severe Stroke Topical Reviews
Source: Stroke - August 28, 2017 Category: Neurology Authors: Julian Bosel Tags: Cerebrovascular Disease/Stroke, Intracranial Hemorrhage, Ischemic Stroke Topical Review Source Type: research

Decannulation and Functional Outcome After Tracheostomy in Patients with Severe Stroke (DECAST): A Prospective Observational Study
ConclusionsDecannulation was achieved in 59.4% of stroke patients surviving the first 12  months after tracheostomy and was associated with better functional outcome compared to patients without decannulation. Further prospective studies with larger sample sizes are needed to confirm our results.
Source: Neurocritical Care - July 25, 2017 Category: Neurology Source Type: research

Heart-Shaped Bilateral Medullary Pyramidal Infarction as a Pathognomonic Finding of Anterior Spinal Artery Occlusion
ConclusionAcute BMP infarction may present with flaccid tetraplegia mimicking neuromuscular disorders. When the infarction is recognized early, intravenous thrombolysis can be considered to reduce morbidity of this rare stroke subtype.
Source: Neurocritical Care - May 8, 2017 Category: Neurology Source Type: research

Comparative analysis of in-hospital outcomes between spontaneous vertebral and carotid arterial dissection at National level (P5.048)
Conclusions:Vertebral artery dissection affects younger patients in comparison to carotid dissections, is associated with higher in hospital complications and procedures, probably thereby leading to prolonged length of stay and higher hospital charges in comparison with carotid artery dissection. Early diagnoses of vertebral artery dissection as a cause of ischemic stroke in the posterior circulation is imperative to improve outcomes.Disclosure: Dr. Qureshi has nothing to disclose. Dr. Afzal has nothing to disclose. Dr. Qureshi has nothing to disclose. Dr. Khatri has nothing to disclose. Dr. Piriyawat has nothing to disclo...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Qureshi, I., Afzal, M.-R., Qureshi, M., Khatri, R., Piriyawat, P., Rodriguez, G., Cruz-Flores, S., Maud, A. Tags: Neurocritical Care: Ischemic Injury Source Type: research

Hospital utilization, length stay and inhospital mortality in patients with subarachnoid hemorrhage among different racial groups (P2.300)
Conclusions:There are significant differences in hospital utilization, in hospital mortality, LOS and disposition among different racial groups. Interestingly minorities have higher utilization and lower inhospital mortality compared to Whites. Further studies needs to be warranted.Disclosure: Dr. Maud has nothing to disclose. Dr. Qureshi has nothing to disclose. Dr. Afzal has nothing to disclose. Dr. Qureshi has nothing to disclose. Dr. Piriyawat has nothing to disclose. Dr. Khatri has nothing to disclose. Dr. Rodriguez has nothing to disclose. Dr. Cruz-Flores has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Maud, A., Qureshi, M., Afzal, M.-R., Qureshi, I., Piriyawat, P., Khatri, R., Rodriguez, G., Cruz-Flores, S. Tags: Subarachnoid Hemorrhage, Intracranial Aneurysm, and Other Cerebrovascular Malformations Source Type: research

"I believe in miracles": Implications for the Neuro-ICU (P3.181)
Conclusions:Preliminary data lack robustness to make definitive conclusions, however suggest possibility of shorter hospital LOS in those who don’t believe in miracles. Involvement of spiritual care early in the ICU may assist in important decision making with patients and family members.Disclosure: Dr. Ramineni has nothing to disclose. Dr. Dangayach has nothing to disclose. Dr. Griffiths has nothing to disclose. Dr. Keogh has nothing to disclose. Dr. Wheelwright has nothing to disclose. Dr. Sharma has nothing to disclose. Dr. Gidwani has nothing to disclose. Dr. Ahmad has nothing to disclose. Dr. Bederson has nothin...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Ramineni, A., Dangayach, N., Griffiths, S., Keogh, M., Wheelwright, D., Sharma, V., Gidwani, U., Ahmad, J., Bederson, J., Mocco, J., Mayer, S. Tags: Neurocritical Care: NICU Issues Source Type: research

Tracheostomy, Extubation, Reintubation: Airway Management Decisions in Intubated Stroke Patients
Conclusion: Airway management decisions in intubated stroke patients represent a clinical challenge. Classical weaning criteria and parameters reflecting the patient's state of consciousness are not reliably predictive of extubation success. Criteria more closely related to airway safety and secretion handling may provide the most relevant information and should therefore be assessed by specific clinical scoring systems.Cerebrovasc Dis 2017;44:1-9
Source: Cerebrovascular Diseases - April 11, 2017 Category: Neurology Source Type: research

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