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The Hospital to Home Transition Following Acute Stroke
This article examines TOC interventions in stroke populations published after the 2011 Agency for Healthcare Research and Quality report. Early supported discharge is the leading TOC intervention. Diversity of outcome measures and use of poorly defined comparators limits generalizability. There is no clear best practice to define interventions targeted at the hospital to home transition.
Source: Nursing Clinics of North America - June 7, 2019 Category: Nursing Authors: DaiWai M. Olson, Shannon B. Juengst Source Type: research

Invasive Neuromonitoring in the Stroke Patient
With advances in technology, the options to manage patients with neurologic injuries are often complex. Critical care management of neurologic injury has historically focused on the prevention of secondary ischemic injury through aggressive management of intracranial pressure (ICP) and maintenance of adequate cerebral perfusion pressure (CPP). However, ICP monitoring alone does not identify ischemic changes that herald patient deterioration. Advocates of multimodality monitoring cite the value of early detection of changes in brain oxygenation levels and brain metabolism as advantageous in optimizing stroke outcomes. ICP m...
Source: Critical Care Nursing Clinics of North America - January 2, 2023 Category: Nursing Authors: Carey Heck Source Type: research

Management of Chronic Hypertension Following Intracerebral Hemorrhage
Acute blood pressure control after a cerebrovascular event is integral in the immediate care of these patients to preserve perfusion to ischemic areas and prevent intracerebral bleeding. The majority of patients with ischemic stroke or intracerebral hemorrhage (ICH) present with preexisting hypertension and therefore require a treatment plan after the acute phase. The presence of chronic hypertension after ICH has often been discussed as a modifiable risk factor for recurrent events. Clinical evidence is relatively lacking for clinicians to understand the extent of blood pressure lowering and the optimal agents to use in t...
Source: Critical Care Nursing Quarterly - March 4, 2019 Category: Nursing Tags: Original Articles Source Type: research

Challenges in the hemodynamic management of acute nontraumatic neurological injuries
Purpose of review To appraise the evidence from the literature and suggest an integrated hemodynamic approach of early and delayed phases of acute ischemic stroke (AIS), subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH). Recent findings In AIS, the research aims to evaluate the optimal pressure control before, during and after the revascularization, to optimize the perfusion in the ischemic areas, minimizing the risk of hemorrhage or secondary damage to already infarcted areas. In the early phase of SAH, systemic pressure should be controlled to balance the risk of stroke, hypertension-related reb...
Source: Current Opinion in Critical Care - March 8, 2022 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Chiara Robba Source Type: research

Fluid therapy and the hypovolemic microcirculation
Purpose of review: In shock states, optimizing intravascular volume is crucial to promote an adequate oxygen delivery to the tissues. Our current practice in fluid management pivots on the Frank-Starling law of the heart, and the effects of fluids are measured according to the induced changes on stroke volume. The purpose of this review is to evaluate the boundaries of current macrohemodynamic approach to fluid administration, and to introduce the microcirculatory integration as a fundamental part of tissue perfusion monitoring. Recent findings: Macrocirculatory changes induced by volume expansion are not always coupled to...
Source: Current Opinion in Critical Care - July 7, 2015 Category: Nursing Tags: INTRAVENOUS FLUIDS: Edited by Bertrand Guidet Source Type: research

Fluid bolus therapy: monitoring and predicting fluid responsiveness
Purpose of review: When a condition of hypoperfusion has been identified, clinicians must decide whether fluids may increase blood flow or whether other therapeutic approaches are needed. For this purpose, several tests and parameters have been introduced in clinical practice to predict fluid responsiveness and guide therapy. Recent findings: Fluid challenge is the gold standard test to assess the preload dependence of the patients. Moreover, several parameters and tests avoiding fluid administration are now available. Pulse pressure variation and stroke volume variation are based on heart–lung interaction and can be use...
Source: Current Opinion in Critical Care - September 9, 2015 Category: Nursing Tags: CARDIOVASCULAR SYSTEM: Edited by Maurizio Cecconi Source Type: research

The crashing patient: hemodynamic collapse
Purpose of review Rapid restoration of tissue perfusion and oxygenation are the main goals in the resuscitation of a patient with circulatory collapse. This review will focus on providing an evidence based framework of the technological and conceptual advances in the evaluation and management of the patient with cardiovascular collapse. Recent findings The initial approach to the patient in cardiovascular collapse continues to be based on the Ventilate–Infuse–Pump rule. Point of care ultrasound is the preferred modality for the initial evaluation of undifferentiated shock, providing information to narrow the diffe...
Source: Current Opinion in Critical Care - November 2, 2017 Category: Nursing Tags: EMERGENCIES IN CRITICAL CARE: Edited by Christopher W. Seymour Source Type: research

Cerebral Perfusion Monitoring in Adult Patients Following Cardiac Surgery: An Observational Study.
CONCLUSIONS: The prevalence of low cerebral oximetry values underscores the importance of increasing the sensitivity of monitoring tools. Further evaluation is required to assess the value of this modality and the role of nurses in optimizing neurocognitive outcomes. PMID: 29284341 [PubMed - as supplied by publisher]
Source: Contemporary Nurse - December 30, 2017 Category: Nursing Tags: Contemp Nurse Source Type: research

The Role of Venoarterial Extracorporeal Membrane Oxygenation in Postcardiotomy Cardiogenic Shock
This article discusses patient assessment and management with anticoagulation, sedation, ventilation, and nutrition. Complications may occur, including bleeding, hemolysis, infection, acute kidney injury, stroke, left ventricular distention, limb ischemia, and upper body hypoxia. Patients may recover enough myocardial function to be weaned from ECMO or may be transitioned to a ventricular assist device or transplant. Quality of life may be affected by VA ECMO but may be no different than patients with other chronic health issues.
Source: Critical Care Nursing Clinics of North America - June 17, 2019 Category: Nursing Authors: P. Lynn McGugan Source Type: research

Treatment targets based on autoregulation parameters in neurocritical care patients
Purpose of review This review summarizes the physiological basis of autoregulation-oriented therapy in critically ill patients, with a particular emphasis on individual targets based on parameters that describe autoregulation of cerebral blood flow. Recent findings The concepts of optimal cerebral perfusion (CPPopt) and arterial pressures (ABPopt), which both take advantage of continuous measures of cerebral autoregulation, recently have been introduced into clinical practice. It is hypothesized that if both pressures are used as individual targets and followed, the incidence and severity of dysautoregulation will dim...
Source: Current Opinion in Critical Care - March 6, 2020 Category: Nursing Tags: ACUTE NEUROLOGICAL PROBLEMS: Edited by Peter Le Roux Source Type: research